Intramedullary devices fixation versus plate fixation for adult displaced mid-shaft clavicle fractures: an update meta-analysis

Nowadays, the exact efficacy of intramedullary devices fixation and plate fixation for adult displaced midshaft clavicle fractures (DMCF) is still debated. This study aims to re-assess the functional outcomes and complications of the two optimal surgical approaches. Cochrane Central Register of Controlled Trials, EMABASE, and PubMed databases were searched for the literature that studied the efficacy of intramedullary devices fixation versus plate fixation for acute DMCF before August 2015. This meta-analysis focused on the Constant Shoulder Score, Oxford Shoulder Score and the incidence of infection, implant irritation, implant failure and nonunion. Revman 5.2 was used to analyze the difference between two approaches. Six trials altogether including 335 fractures were eligible, in which 163 clavicle fractures were treated with intramedullary repair and 172 with plates. The final results of our study indicate that the Constant Shoulder Score is significantly higher (MD, 2.64; 95% CI, 1.42 to 3.87; P<0.05) and the infection rate is slightly lower (RR, 0.25; 95% CI, 0.07 to 0.96; P<0.05) in intramedullary devices fixation group than the plate fixation group. And the occurrence of other adverse effects remains the same. The present meta-analysis indicates that intramedullary devices fixation could improve the functional recovery and reduce the infection rate. The intramedullary approach does not yield the irritation rate significantly.