Journal Article

Advancing Surgical Decisions: Meta-Analysis of Intramedullary Fixation vs. Plating for Midshaft Clavicle Fractures

2024

Overview

Midshaft clavicle fractures are common orthopedic injuries often requiring surgical intervention, with plate fixation (PF) and intramedullary fixation (IMF) being the primary treatment options. PF provides good stability but is associated with complications such as hypertrophic scars, painful scars, implant protrusion, and the need for hardware removal. Intramedullary fixation (IMF) offers a less invasive alternative, though its comparative effectiveness remains debated. This meta-analysis aimed to compare clinical outcomes between IMF and PF for midshaft clavicle fractures, incorporating studies published in the last five years. We systematically searched Google Scholar, MEDLINE, and the Cochrane Library for comparative studies. Primary outcomes included functional assessments (DASH and Constant scores), while secondary outcomes focused on VAS scores, surgical parameters, and complications. Nine studies were included. Functional outcomes were similar between groups for the DASH score, but IMF demonstrated a significant advantage in the Constant score, with the maximum improvement observed at 24 weeks (MD 4.38, 95% CI 3.47 to 5.28). IMF also resulted in lower VAS scores, indicating reduced pain, particularly at 1 and 7 days post-surgery. No significant difference was found in major complications, but IMF had a higher risk of implant irritation (OR 2.37, 95% CI 1.09 to 5.14) and a lower risk of hypertrophic scarring (OR 0.12, 95% CI 0.03 to 0.42). IMF has better improvement in all surgical parameters. In conclusion, IMF offers superior surgical efficiency, a more favorable pain profile, and fewer complications, making it an effective treatment option for midshaft clavicle fractures.

• Publisher: Azerbaijan Medical Journal
• Subject: Scars