Daniel Z You1,2, Halli Krzyzaniak3, Joseph K Kendal1,2, C Ryan Martin1,2, Prism S Schneider1,2. 1. Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Canada. 2. McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada. 3. Cumming School of Medicine, University of Calgary, Calgary, Canada.
Abstract
INTRODUCTION: Open reduction and internal fixation (ORIF) of displaced midshaft clavicle fractures is associated with higher union rates and earlier functional recovery. However, ORIF with plate fixation is associated with complications including implant irritation and implant failure. Dual plate fixation provides fixation in orthogonal planes, and uses a lower profile fixation technique in comparison to pre-contoured and surgeon-contoured small-fragment locking plates, which may be more prominent. The objective of this study was to conduct a systematic review to summarize outcomes and complications associated with surgical fixation of displaced acute midshaft clavicle fractures with dual plate fixation. METHODS: Using a predetermined study protocol in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, the databases MEDLINE, EMBASE, and CENTRAL were searched from inception to 2020 to identify studies reporting outcomes in acute midshaft clavicle fractures treated with dual plate fixation. All clinical studies which reported on outcomes of dual plating in patients with acute midshaft clavicle fractures were included. Baseline demographics, plate fixation constructs, fracture union rates, implant removal rates, maintenance of reduction, symptomatic implant rates, wound complications, and functional outcomes were extracted. All extracted data were recorded, and descriptive statistics were summarized. Meta-analysis was performed on fracture union rates and implant removal rates using random-effects modeling using Mantel-Haenszel weighting. RESULTS: Our literature search identified 2226 unique abstracts, of which eight studies met our study inclusion criteria following review. A total of 278 patients made up of 79.8% male with an average age of 36.0 years were included. The overall dual plate implant removal rate was 4.2% with excellent rates of union reported. Moreover, single plate fixation was associated with a 3.9-fold increased implant removal rate compared to dual plate fixation. CONCLUSION: Results from this systematic review demonstrate that ORIF of displaced midshaft clavicle fractures using a dual plate fixation technique is a viable option to reduce the incidence of implant removal, without negatively impacting the rate of fracture union. LEVEL OF EVIDENCE: Therapeutic Level III.
INTRODUCTION: Open reduction and internal fixation (ORIF) of displaced midshaft clavicle fractures is associated with higher union rates and earlier functional recovery. However, ORIF with plate fixation is associated with complications including implant irritation and implant failure. Dual plate fixation provides fixation in orthogonal planes, and uses a lower profile fixation technique in comparison to pre-contoured and surgeon-contoured small-fragment locking plates, which may be more prominent. The objective of this study was to conduct a systematic review to summarize outcomes and complications associated with surgical fixation of displaced acute midshaft clavicle fractures with dual plate fixation. METHODS: Using a predetermined study protocol in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, the databases MEDLINE, EMBASE, and CENTRAL were searched from inception to 2020 to identify studies reporting outcomes in acute midshaft clavicle fractures treated with dual plate fixation. All clinical studies which reported on outcomes of dual plating in patients with acute midshaft clavicle fractures were included. Baseline demographics, plate fixation constructs, fracture union rates, implant removal rates, maintenance of reduction, symptomatic implant rates, wound complications, and functional outcomes were extracted. All extracted data were recorded, and descriptive statistics were summarized. Meta-analysis was performed on fracture union rates and implant removal rates using random-effects modeling using Mantel-Haenszel weighting. RESULTS: Our literature search identified 2226 unique abstracts, of which eight studies met our study inclusion criteria following review. A total of 278 patients made up of 79.8% male with an average age of 36.0 years were included. The overall dual plate implant removal rate was 4.2% with excellent rates of union reported. Moreover, single plate fixation was associated with a 3.9-fold increased implant removal rate compared to dual plate fixation. CONCLUSION: Results from this systematic review demonstrate that ORIF of displaced midshaft clavicle fractures using a dual plate fixation technique is a viable option to reduce the incidence of implant removal, without negatively impacting the rate of fracture union. LEVEL OF EVIDENCE: Therapeutic Level III.
Authors: Kamil Amer; Brendan Smith; Jennifer E Thomson; Dominick Congiusta; Mark C Reilly; Michael S Sirkin; Mark R Adams Journal: J Orthop Trauma Date: 2020-01 Impact factor: 2.512
Authors: Mark L Prasarn; Kathleen N Meyers; Geoffrey Wilkin; David S Wellman; Daniel B Chan; Jaimo Ahn; Dean G Lorich; David L Helfet Journal: Arch Orthop Trauma Surg Date: 2015-09-16 Impact factor: 3.067
Authors: Rafael Serrano; Amrut Borade; Hassan Mir; Anjan Shah; David Watson; Anthony Infante; Mark A Frankle; Mark A Mighell; H Claude Sagi; Daniel S Horwitz; Roy W Sanders Journal: J Orthop Trauma Date: 2017-09 Impact factor: 2.512
Authors: Timothy Leroux; David Wasserstein; Patrick Henry; Amir Khoshbin; Tim Dwyer; Darrell Ogilvie-Harris; Nizar Mahomed; Christian Veillette Journal: J Bone Joint Surg Am Date: 2014-07-02 Impact factor: 5.284
Authors: Malcolm R DeBaun; Michael J Chen; Sean T Campbell; L Henry Goodnough; Cara Lai; Brett P Salazar; Julius A Bishop; Michael J Gardner Journal: J Orthop Trauma Date: 2020-07 Impact factor: 2.512