An evaluation of treatment options for medial, midshaft, and distal clavicle fractures: a systematic review and meta-analysis

作者：Christopher Vannabouathong, Justin Chiu, Rahil Patel, Shreyas Sreeraman, Elias Mohamed, Mohit Bhandari, Kenneth J. Koval, Michael D. McKee · 发表于：JSES International · 年份：2020 · DOI：10.1016/j.jseint.2020.01.010 · 被引用次数：36 · 研究领域：Shoulder and Clavicle Injuries、Trauma Management and Diagnosis、Spinal Fractures and Fixation Techniques

BACKGROUND: The majority of clavicle fractures are midshaft injuries, although fractures of the distal or medial fragment also occur. The aim of this study was to review the current evidence on these injuries to help inform future treatment plans. METHODS: We searched for studies comparing interventions for medial, midshaft, or distal clavicle fractures; however, we did not identify any comparative studies on medial fractures and performed a secondary search on this topic. We conducted Bayesian network meta-analyses, although this was not feasible with studies on medial fractures and we described their results qualitatively. RESULTS: For midshaft fractures, we found statistically significant improvements in function and time to radiographic union with plating, an elastic stable intramedullary nail (ESIN), and the Sonoma CRx intramedullary nail over nonoperative treatments. Both plating and an ESIN also showed significantly lower risks of nonunion and malunion relative to nonoperative methods. For distal fractures, a locking plate (LP) with or without coracoclavicular (CC) suturing yielded significantly better outcomes over K-wires with or without tension bands, CC suturing alone, an LP with a CC screw, a hook plate, and a sling. For medial fractures, plating may result in more favorable functional and union-related outcomes, although implant irritation may occur. In addition, K-wires, tension bands, and a screw with sutures demonstrated success when plating was technically no...