Meta-analysis Of The Treatment Of Displaced Midshaft Clavicle Fractures

In this paper,statistical methods of meta-analysis was used to compare the treatment of displaced fracture of the middle clavicle.The treatment include non-operative and operative methods.The operative methods include plate fixation and intramedullary nail fixation.We retrieved the PubMed,EMBASE and Chorane Library databases which included randomized controlled trials(RCTs)comparing open reduction and plate internal fixation(ORPF)with non-surgical treatment(NT)for displaced fractures of the middle clavicle,and RCTs of open reduction plate internal fixation(ORPF)and intramedullary nail fixation(IMF)was conducted.We did two meta-analyses based on RCTs and summarized the results to compare the advantages and disadvantages of the three therapies.The first part is the meta-analysis of ORPF and NT: we collected the appearance problems recorded,comparing the overall appearance,local appearance and appearance unsatisfactory rate of the two;at the same time,we compared the malunion rate,fracture nonunion and functional results of the two.The second part is meta-analysis of ORPF and IMF.The main indicators were implant failure rate,infection rate and irritation,and the secondary indicators were fracture nonunion rate and functional outcome.According to the conclusions of meta-analysis of the above two groups,the best treatment plan was obtained.The first group of meta-analysis concluded that ORPF was slightly better than non-surgical treatment,and ORPF had obvious advantages in overall appearance of shoulder,malunion rate and nonunion of fracture.ORPF was not higher than non-surgical treatment in the rate of appearance dissatisfaction,and there was no statistical difference in local appearance and DASH score.The second group of meta-analysis conclusion: current evidence shows that the efficacy of IMF is slightly better than that of ORPF: the infection rate and stimulation rate of IMF group are lower than those of ORPF group,which has obvious advantages.There was no significant difference in implant failure rate,fracture nonunion and functional score between the two groups.Based on the analysis of the above two groups,we conclude that intramedullary nailing is a better treatment at present.