Low profile dual plating for mid-shaft clavicle fractures: a meta-analysis and systematic review of observational studies

Rompen, Ingmar F.; Wall, Bryan Joost Marinus van de; Heijl, Mark van; Bünter, Isabelle; Diwersi, Nadine; Roth, Franz; Migliorini, Filippo; Link, Björn‐Christian; Knobe, Matthias; Babst, Reto; Beeres, Frank J.P.

doi:10.1007/s00068-021-01845-3

Cited by 9 publications

(5 citation statements)

References 23 publications

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“…Rompen et al, in their meta-analysis study on this subject, reported that the low profile DP had lower implant-related complications compared to a 3.5 mm SP, and the union and infection rates were similar. [ 22 ] In our study, no significant difference was observed between the SP and DP groups in terms of union and infection. Moreover, it is promising that patients with DP have better time to return to work and better clinical outcomes in the early period.…”

Section: Discussioncontrasting

confidence: 53%

Single-plate versus double-plate comparison in the surgical treatment of comminuted clavicle fractures: Is the secondary plate reliable?

Yurteri,

Mercan,

Gem

et al. 2023

Medicine

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The objective of this study is to retrospectively assess the use of single-plate (SP) and double-plate (DP) fixation in the open reduction and internal fixation of comminuted clavicle fractures, focusing on fracture union and complications. We retrospectively evaluated comminuted diaphyseal clavicle fractures (Arbeitsgemeinschaft für Osteosynthesefragen type 15.B1-3) treated with open reduction and internal fixation and having a minimum 1-year follow-up. Two patient cohorts were identified: DP (utilizing a superiorly located clavicle-specific plate and an anteriorly located tubular plate) and SP (utilizing a superiorly located clavicle-specific plate). These groups were compared in terms of union time, peri-incisional numbness, implant irritation, return to work time, union rates, re-operation rates, Disabilities of Arm, Shoulder and Hand (DASH), and American Shoulder and Elbow Surgeons (ASES) scores. The study included 27 SP and 23 DP patients meeting the inclusion criteria. There was no significant difference between the 2 cohorts in terms of union time, peri-incisional numbness, implant irritation, return to work time, union rates, re-operation rates, DASH, and ASES scores at the end of the first year (P = .889, P = 1.00, P = .122, P = 1.00, P = 1.00, P = .493, P = .736, P = .762, P = .937 respectively). However, it was observed that the DP group showed a significantly earlier return to work time and better DASH scores at 3rd and 6th months, whereas the SP group exhibited significantly better ASES scores at 3rd and 6th months (P = .034, P = .016, P = .032, P = .036, P = .021, respectively). No significant difference was observed in terms of union and complications in acute clavicle fractures treated with SP and DP fixation. The DP group demonstrated an earlier return to work and superior early functional scores compared to the SP group. Our findings suggest that a secondary plate can be reliably used, particularly in situations where clavicle fracture fixation is insufficient or in cases of comminuted clavicle fractures.

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Section: Discussioncontrasting

confidence: 53%

Single-plate versus double-plate comparison in the surgical treatment of comminuted clavicle fractures: Is the secondary plate reliable?

Yurteri,

Mercan,

Gem

et al. 2023

Medicine

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“…Many studies have reported DP utilizing low-profile plates to yield lower reoperation rates, without compromising fixation or healing 25,27,28,38,39 . More recently, investigators have attributed the observed reduction in the rates of secondary surgeries to the smaller implant profile of the DP construct, resulting in less implant prominence and, consequently, a lower incidence of symptomatic hardware 25,28,38,39 . An investigation conducted by Prasarn et al found that a low-profile DP construct was not merely equivalent biomechanically but had a multiplanar stiffness advantage over an SP construct 25 .…”

Section: Discussionmentioning

confidence: 99%

“…Literature on the economic profile of DP is limited, and in particular we are aware of no evidence comparing the cost-effectiveness of DP and SP. Many studies have reported DP utilizing low-profile plates to yield lower reoperation rates, without compromising fixation or healing 25,27,28,38,39 . More recently, investigators have attributed the observed reduction in the rates of secondary surgeries to the smaller implant profile of the DP construct, resulting in less implant prominence and, consequently, a lower incidence of symptomatic hardware 25,28,38,39 .…”

Section: Discussionmentioning

confidence: 99%

Dual Versus Single Plate Fixation of Displaced Midshaft Clavicle Fractures

Charles,

Kumar,

Reddy

et al. 2023

Journal of Bone and Joint Surgery

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Background: Prior studies have highlighted lower rates of reoperation if fixation of a displaced midshaft clavicle fracture is performed with dual plating (DP) compared with single plating (SP). Despite higher initial costs associated with the DP construct, the observed reduction in secondary surgeries compared with the SP construct may make it a more cost-effective treatment option. The objective of this study was to assess the cost-effectiveness of DP compared with SP in patients with operatively indicated displaced midshaft clavicle fractures. Methods: We developed a decision tree to model the occurrence of postoperative complications (acute hardware complications, wound healing issues, deep infection, nonunion, and symptomatic hardware) associated with secondary surgeries. Complication-specific risk estimates were pooled for both plating techniques using the available literature. The time horizon was 2 years, and the analysis was conducted from the health-care payer’s perspective. The costs were estimated using direct medical costs, and the benefits were measured in quality-adjusted life-years (QALYs). We assumed that DP would be $300 more expensive than SP initially. We conducted probabilistic and 1-way sensitivity analyses. Results: The model predicted reoperation in 6% of patients in the DP arm compared with 14% of patients in the SP arm. In the base case analysis, DP increased QALYs by 0.005 and costs by $71 per patient, yielding an incremental cost-effectiveness ratio (ICER) of $13,242 per QALY gained. The sensitivity analysis demonstrated that the cost-effectiveness of DP was driven by the cost of the index surgery, risk of symptomatic hardware, and nonunion complications with SP and DP. At a willingness-to-pay threshold of $100,000 per QALY gained, 95% of simulations suggested that DP was cost-effective compared with SP. Conclusions: When indicated, operative management of displaced midshaft clavicle fractures using DP was found to be cost-effective compared with SP. Despite its higher initial hardware costs, DP fixation appears to offset its added costs with greater health utility via lower rates of reoperation and improved patient quality of life. Level of Evidence: Economic and Decision Analysis Level II. See Instructions for Authors for a complete description of levels of evidence.

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“…We put out a PROSPERO-Protocol before extracting the data (registration number: CRD42021249213). The methods are standardized and have been used in the previous meta-analysis of our research group [20][21][22][23].…”

Section: Methodsmentioning

confidence: 99%

Intraoperative imaging in hip arthroplasty: a meta-analysis and systematic review of randomized controlled trials and observational studies

et al. 2023

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Background Intraoperative fluoroscopy (IFC) is gaining popularity in total hip arthroplasty (THA), with the aim to achieve better component positioning and therefore eventually reduced revision rates. This meta-analysis investigated the benefit of IFC by comparing it to intraoperative assessment alone. The primary outcome was component positioning and the secondary outcomes included complications and revision rates. Methods PubMed, Embase and Cochrane Central Register of Controlled Trials were searched for both randomized clinical trials (RCT) and observational studies. Effect estimates for radiographic cup position, offset/leg length difference and outliers from a safe zone were pooled across studies using random effects models and presented as a weighted odds ratio (OR) with a corresponding 95% confidence interval (95% CI). Results A total of 10 observational studies involving 1,394 patients were included. No randomized trials were found. IFC showed no significant reduction in acetabular cup position (inclination and anteversion), offset, leg-length discrepancies, revision (none reported) or overall complication rates. Conclusion The current meta-analysis found no differences in cup positioning, offset, leg length discrepancy, the incidence of complications or revision surgery. It should be acknowledged that the included studies were generally performed by experienced surgeons. The benefit of intraoperative fluoroscopy might become more evident at an early phase of the learning curve for this procedure. Therefore, its role has yet to be defined.

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Low profile dual plating for mid-shaft clavicle fractures: a meta-analysis and systematic review of observational studies

Cited by 9 publications

References 23 publications

Single-plate versus double-plate comparison in the surgical treatment of comminuted clavicle fractures: Is the secondary plate reliable?

Single-plate versus double-plate comparison in the surgical treatment of comminuted clavicle fractures: Is the secondary plate reliable?

Dual Versus Single Plate Fixation of Displaced Midshaft Clavicle Fractures

Intraoperative imaging in hip arthroplasty: a meta-analysis and systematic review of randomized controlled trials and observational studies

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