Plating versus intramedullary fixation for acute displaced mid-shaft clavicle fractures: a meta-analysis

Background: Surgical treatment of acute displaced mid-shaft fractures of the clavicular remains challenging. In this meta-analysis, we pooled studies to compare plating with intramedullary fixation for this injury. Methods: The electronic databases MEDLINE, EMABSE, BIOSIS and Google scholar were searched. RCTs and cohort studies evaluating plating versus intramedullary fixation for displaced mid-shaft clavicle fracture were collected. The quality of the study was assessed, and meta-analyses were performed with the Cochrane Collaboration's REVMAN 5.0 software. Results: Three RCTs and eleven cohort studies involving 934 patients were included. There were 421 patients treated with intramedullary fixation and 513 cases for plating. Functional outcomes, rate of bone union, infection and implant failure were compared and no significant difference was found. Intramedullary fixation was associated with a shorter time to bone union (MD -0.60 weeks, 95% CI -1.11 to -0.10) and for surgery (MD -21.29 minutes; 95% CI -27.93 to -14.65). Conclusion: Both plating and intramedullary fixation techniques are equally effective for the surgical treatment of acute displaced mid-shaft clavicle fractures and the intramedullary fixation technique is quicker with a shorter operative time and faster to bone union. It can be regard as an attractive alternative to plating. In the future, high quality and well designed RCTs are required to support these findings.