gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

Artikel

Artikel empfehlen

Operative Versus Non-Operative Outcomes Of Middle Clavicle Fractures: A Systematic Review And Meta-Analysis

Meeting Abstract

Suche in Medline nach

  • presenting/speaker Kamil Amer - Rutgers New Jersey Medical School, Newark, New Jersey, United States
  • Dominick Congiusta - Rutgers New Jersey Medical School, Newark, New Jersey, United States
  • Jennifer Thomson - Rutgers New Jersey Medical School, Newark, New Jersey, United States
  • Matthew Li - Rutgers New Jersey Medical School, Newark, New Jersey, United States
  • Rami Amer - Rutgers New Jersey Medical School, Newark, New Jersey, United States
  • Ahmed Chaudhry - Rutgers New Jersey Medical School, Newark, New Jersey, United States
  • Mark Reilly - Rutgers New Jersey Medical School, Newark, New Jersey, United States
  • Mark Adams - Rutgers New Jersey Medical School, Newark, New Jersey, United States
  • Michael Sirkin - Rutgers New Jersey Medical School, Newark, New Jersey, United States

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1920

doi: 10.3205/19ifssh0013, urn:nbn:de:0183-19ifssh00133

Veröffentlicht: 6. Februar 2020

© 2020 Amer et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.

Gliederung

Text

Objectives/Interrogation: Midshaft clavicle fractures are among the most common bone injuries to the body. Superiority of operative vs. nonoperative treatment remains unclear, but recent studies have shown that nonoperative outcomes are not as favorable as once thought. We present a meta-analysis comparing treatment modalities of clavicle fractures.

Methods: PubMed and OVID were queried to identify studies published before October 2017 that reported on outcomes after operative vs. nonoperative treatment for clavicle fractures. Primary outcomes included rates of nonunion, symptomatic malunion, shoulder function (Constant and DASH scores), and need for secondary operations. Secondary analysis compared outcomes after different types of operative fixation vs. nonoperative treatment. Data were analyzed using t-test on the mean differences for statistical differences.

Results and Conclusions: Sixteen studies (1,206 patients) met inclusion criteria. Risk of nonunion was lower in the operatively treated patients (RR=0.21, 95% CI=0.06-0.32). Risk of symptomatic malunion was lower in the operatively treated patients (RR=0.17, 95% CI= 0.06-0.32). Constant and DASH scores were higher with surgical fixation compared to nonoperative management with mean differences of 6.8 points (95% CI, 2.1-10.9). Surgery with plates resulted in better DASH and Constant scores, fewer complications, and lower patient dissatisfaction (p< 0.05). There was no difference in the risk of secondary operation between groups (p=0.27) or long-term function in patients treated with nails or plates (p=0.41). Patients treated with plate fixation had >2 times increased risk of treatment failure compared to those treated with nails (p=0.04) (Table 1 [Tab. 1]).

This study is the largest, most current, and most inclusive meta-analysis of clavicle fracture management to date. Our data show that operative repair results in lower rates of malunion, nonunion, and complications, and higher DASH and Constant functional scores. There were higher rates of failure with plate fixation. Our primary limitation was variable heterogeneity. Further studies need to be conducted to confirm these findings.