Plate fixation versus intramedullary fixation for displaced mid-shaft clavicle fractures: a systematic review

Abstract

PurposeThe optimal surgical approach for displaced midshaft clavicle fracture remains controversial. The objective of this systematic review is to compare functional outcome and complications after plate fixation and intramedullary fixation for displaced midshaft clavicle fractures.MethodsA computer aided search of PUBMED and Embase was carried out on January 11th 2011. Every study that was published in the English, German, French or Dutch language was considered for inclusion. A total of four studies could be included of which two compared intramedullary fixation versus plate fixation, and two compared intramedullary fixation and plate fixation versus conservative treatment for displaced midshaft clavicle fractures. Studies that compared plate fixation with intramedullary fixation in patients with fresh unilateral displaced midshaft clavicle fractures were included. Dislocation or displacement had to be mentioned in the inclusion criteria of the study for inclusion in this review. The modified version of the Cochrane Bone, Joint and Muscle Trauma Group’s former quality assessment tool was used. Furthermore, the studies included were scored according to the GRADE approach to assess the quality. The chosen studies were summarised in a data-extraction form. Because of the different study designs and characteristics data were summarised separately for each study.ConclusionsHigh quality evidence from one study and low quality evidence from three studies showed no difference in functional outcome or complications after plate fixation or intramedullary fixation for displaced midshaft clavicle fractures.

Biomechanical comparison of the Locking Compression superior anterior clavicle plate with seven and ten hole reconstruction plates in midshaft clavicle fracture stabilisation

“…2b) are the most frequently used implants [4]. Yet, in our clinic, surveys have revealed a relatively high complication rate with this plate, similar to those published by Wijdicks et al and Houwert et al [5,6]. Over a period of two years, five implant failures approximately three months postoperatively were observed (Fig.…”

Mini-open Treatment Using Plate of Clavicle Mid-shaft Fractures

“…Other types of internal fixation that have been used include IM devices, Kirschner wire, rush nails, and Kuntscher nails. 17,18) IM fixation can be accomplished with smaller incisions, less dissection, and soft tissue stripping, and it may permit callus formation due to relative stability and protection of the supraclavicular nerves. Otherwise, complications related to IM fixation include hardware prominence, implant migration, implant breakage, vulnerable to rotational force, and deformity after early ROM, which leads to difficulty removing the nail.…”

“…10) For plate fixation, different types of plates are available: (pre-contoured) dynamic compression plates, tubular plates, reconstruction plates, anatomical plates, or locking plates. 18) Reconstruction plates have an advantage as they conform to the contour of the clavicle, whereas anatomical plates allow contouring of plates to fit the patient's anatomy. Anatomic pre-contoured locking plates are widely used for the following advantages: strong fixation due to locking between the screw and plate as well as blood supply preservation due to minimal contact between the plate and cortical bone.…”

Treatment of Midshaft Clavicle Fractures: Application of Local Autograft With Concurrent Plate Fixation

“…2,6,13,25 Open reductioneinternal fixation with the implementation of either contoured plates or intramedullary nails is a commonly used technique for midshaft clavicular fracture fixation. 2,11,[13][14][15][16][17][18][19][20] In instances in which the indication for surgical treatment is fracture nonunion, autologous ICBG may be added to provide a scaffolding for growth and facilitate osteosynthesis. 2,11,[13][14][15][16][17] However, studies have associated ICBG harvesting with significant donor-site morbidity.…”

“…2,11,[13][14][15][16][17] Internal fixation of midshaft clavicle fractures may involve the use of contoured plates or intramedullary nails. [18][19][20] In addition, autologous iliac crest bone graft (ICBG) has proved to augment osteosynthesis during fixation of nonunion fractures through the release of osteogenic factors. 2,11,[13][14][15][16][17] However, studies have associated ICBG harvesting with significant donor-site morbidity, including neurologic and vascular injury, incisional hernia, donor-site fracture, and deep infection.…”