title: Plate fixation versus intramedullary fixation for midshaft clavicle fractures: Meta-analysis of complications and functional outcomes.
abstract: OBJECTIVE
  This analysis critically compares publications discussing complications and functional outcomes of plate fixation (PF) versus intramedullary fixation (IF) for midshaft clavicle fractures.
  
  
  METHODS
  Relevant studies published between January 1990 and October 2014, without language restrictions, were identified in database searches of PubMed®, Medline®, Embase and the Chinese National Knowledge Infrastructure (CNKI). Studies that compared postoperative complications and functional outcomes between PF and IF for midshaft clavicle fractures, and provided sufficient data for analysis, were included in this meta-analysis.
  
  
  RESULTS
  After strict evaluation, 12 studies were included in this meta-analysis. Studies encompassed 462 participants in the PF group and 440 in the IF group. Study participants were followed up for ≥1 year. Outcomes were superior with IF compared with PF in terms of shoulder constant score at 6-month follow-up, fewer symptomatic hardware complications, lower rate of refracture after hardware removal and less hypertrophic scarring. In other aspects, such as functional recovery at 12-months and 24-months, Disability of Arm, Shoulder and Hand (DASH) questionnaire results at 12-month follow-up, shoulder motion range, rates of superficial infection, temporary brachial plexus lesion, nonunion, malunion, delayed union, implant failure and need for major revision, both techniques were similar.
  
  
  CONCLUSIONS
  Findings of this meta-analysis suggest that, in many respects, IF was superior to PF for the management of midshaft clavicle fractures. This finding could aid surgeons in making decisions on the optimum internal fixation pattern for midshaft clavicular fractures.
authors.affiliation: Emergency Department, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Xiao
authors.affiliation: Emergency Department, The Second Hospital of Hebei Medical University, Shijiazhuang, China Key Laboratory of Emergency Medicine of Hebei Province, Shijiazhuang, China.
authors.forename: Hengbo
authors.initials: H
authors.lastname: Gao
authors.affiliation: Emergency Department, The Second Hospital of Hebei Medical University, Shijiazhuang, China Key Laboratory of Emergency Medicine of Hebei Province, Shijiazhuang, China.
authors.forename: Tuokang
authors.initials: T
authors.lastname: Zheng
authors.affiliation: Emergency Department, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
authors.forename: Jianhui
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Key Laboratory of Emergency Medicine of Hebei Province, Shijiazhuang, China drtian2013@126.com.
authors.forename: Yingping
authors.initials: Y
authors.lastname: Tian
mesh_terms: D000293:Adolescent; D000328:Adult; D001860:Bone Plates; D001917:Brachial Plexus / Q000503:physiopathology; D002968:Clavicle / Q000293:injuries / Q000601:surgery; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000534:rehabilitation*; D050723:Fractures, Bone / Q000150:complications / Q000534:rehabilitation* / Q000601:surgery; D017759:Fractures, Malunited / Q000175:diagnosis / Q000209:etiology / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000473:pathology / Q000503:physiopathology; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D012086:Reoperation / Q000706:statistics & numerical data; D016896:Treatment Outcome
keywords: Midshaft clavicle fractures; intramedullary fixation; meta-analysis; plate fixation