Plate fixation versus intramedullary nail or Knowles pin fixation for displaced midshaft clavicle fractures: A meta-analysis of randomized controlled trials.

研究概要

Twelve randomized controlled trials including a total of 839 patients were included in this meta-analysis comparing intramedullary nail/Knowles pin fixation to plate fixation. Pooled outcomes of interest included Constant scores, Disability of the Arm Shoulder and Hand (DASH) scores, the risk of non-union, revision/re-intervention, re-fracture, infection and removal rate, operative time, incision size, and hospital stay. Results of the meta-analysis found statistically significantly favourable pooled scores in the intramedullary group compared to the plate group (p=0.04). Pooled Constant scores were not statistically significantly different between the two groups (p=0.32); however, in the sensitivity analysis excluding heterogenous studies, pooled Constant scores were statistically significantly better in the intramedullary group (p<0.00001). The pooled risk of non-union (p=0.53), re-intervention/revision (p=0.14), and re-fracture (p=0.14) were not statistically significantly different between groups. In addition, the pooled risk of infection was statistically significantly in favour of the intramedullary group (p=0.003). Pooled operative time (p<0.0001), incision size (p<0.00001), and hospital stay (p<0.0001) were all statistically significantly in favour of the intramedullary group. The risk of removal, in both the full analysis and sensitivity analysis excluding heterogenous studies, was statistically significantly in favour of the plate group (p=0.01, p<0.00001; respectively).