title: Intramedullary Nailing Versus Plate Fixation for the Treatment Displaced Midshaft Clavicular Fractures: A Systematic Review and Meta-Analysis.
abstract: The two commonly performed surgical techniques used to repair displaced midshaft clavicle fractures are plate fixation or intramedullary nailing; however, despite recent evidence, the optimal method to treat such fractures remains a continued topic of debate. A meta-analysis of randomized controlled trials (RCTs) was conducted to evaluate long term function, complications, and operative duration in adult patients receiving intramedullary nailing in comparison to plating. Seven RCTs and three quasi-randomized trials were included. No significant difference was found in long-term function between the two groups (MD: -0.66, 95% CI: -2.03 to 0.71, I2= 62%, p = 0.34). Patients who received plating had a 2.19 times increased risk of treatment failure, but this failed to reach significance (95% CI: 0.93 to 5.15, I2= 0%, p = 0.07). The risk of non-operative complications was 2.11 times higher in patients who received plating and this reached statistical significance (95% CI: 1.38 to 3.23, I2= 53%, p = 0.0006). Finally, plating significantly prolonged operative duration by 20.16 minutes (95% CI: 16.87 to 23.44, I2= 56%, p < 0.00001). Our results suggest that intramedullary nailing and plating provide equivalent long-term functional outcomes; however, plating may lead to a higher risk of treatment failure and non-operative complications.
authors.affiliation: Central Michigan University College of Medicine, CMED Building 1280 S. East Campus St. Mt. Pleasant, MI 48859, USA.
authors.forename: Nasir
authors.initials: N
authors.lastname: Hussain
authors.affiliation: Division of Orthopaedic Surgery, Mount Sinai Hospital, University of Toronto, 600 University Avenue Toronto, Ontario M5G 1X5, Canada.
authors.forename: Corey
authors.initials: C
authors.lastname: Sermer
authors.affiliation: Central Michigan University College of Medicine, CMED Building 1280 S. East Campus St. Mt. Pleasant, MI 48859, USA.
authors.forename: Parker J
authors.initials: PJ
authors.lastname: Prusick
authors.affiliation: Health Sciences Library, McMaster University 1280 Main St. W., HSC 2B Hamilton, Ontario L8S 4K1, Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Banfield
authors.affiliation: West Suffolk Hospital Bury St Edmunds, Suffolk IP33 2QZ, United Kingdom.
authors.forename: Amit
authors.initials: A
authors.lastname: Atrey
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, McMaster University &Centre for Evidence-Based Orthopaedics 293 Wellington Street North, Suite 110 Hamilton, Ontario, L8L 8E7, Canada.
authors.forename: Mohit
authors.initials: M
authors.lastname: Bhandari
mesh_terms: D000328:Adult; D001858:Bone Nails; D001860:Bone Plates; D002968:Clavicle / Q000293:injuries / Q000601:surgery*; D005260:Female; D005593:Fracture Fixation, Internal; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D017211:Treatment Failure; D016896:Treatment Outcome