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Review
. 2015 Mar;94(11):e595.
doi: 10.1097/MD.0000000000000595.

Interventions for treating displaced midshaft clavicular fractures: a Bayesian network meta-analysis of randomized controlled trials

Jia Wang  1 , Xiao-Hui Meng, Zhi-Ming Guo, Ying-Hua Wu, Jia-Guo Zhao
Affiliations
Review

Interventions for treating displaced midshaft clavicular fractures: a Bayesian network meta-analysis of randomized controlled trials

Jia Wang et al. Medicine (Baltimore). 2015 Mar.

Abstract

Displaced midshaft clavicle fractures are frequent injuries. There are 3 treatment methods including conservative treatment, plate fixation, and intramedullary pin fixation. However, which is the best treatment remains a topic of debate.To establish the optimum treatment for displaced midshaft clavicular fractures, we did a network meta-analysis to compare 3 treatments in terms of postoperative nonunion and infection.We searched PubMed, the Cochrane Library, and Embase for relevant randomized controlled trials (RCTs) until the end of October 2014. Two investigators independently reviewed the abstract and full text of eligible studies and extracted information. We used WinBUGS 1.4 (Imperial College School of Medicine at St Mary's, London) to perform our Bayesian network meta-analysis. We used the graphical tools in STATA12 (StataCorp, Texas) to present the results of statistical analyses of WinBUGS14. Nonunion and infection were presented as odd ratios (ORs) with 95% confidence intervals (CIs). We also presented the results using surface under the cumulative ranking curve (SUCRA). A higher SUCRA value suggests better results for respective treatment method.Thirteen RCTs were included in our network meta-analysis, with a total of 894 patients randomized to receive 1 of 3 treatments. Nonunion rates were 0.9%, 2.4%, and 11.4% for intramedullary pin fixation, plate fixation, and conservative method, respectively. Nonunion occurred more commonly in patients treated with conservative method than in patients treated with either plate fixation (OR, 0.18; 95% CI, 0.05-0.46) or intramedullary pin fixation (OR, 0.12; 95% CI, 0.01-0.50). There was no significant difference between plate and intramedullary pin fixation in nonunion (OR, 3.64; 95% CI, 0.31-17.27). Furthermore, SUCRA probabilities were 87.8%, 62.0%, and 0.2% for intramedullary pin fixation, plate fixation, and conservative method, respectively. Infection rates were 3.6% and 3.9% for intramedullary pin fixation and plate fixation, respectively. There was no significant difference between plate and intramedullary pin fixation in infection (OR, 3.64; 95% CI, 0.31-17.27). SUCRA probabilities were 46.5% and 8.5% for intramedullary pin and plate fixation, respectively.Our network meta-analysis suggested that intramedullary pin fixation is the optimum treatment method for displaced midshaft clavicle fracture because of the low probabilities of nonunion and infection.

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Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Flow diagram depicting study selection for inclusion in meta-analysis. RCT = randomized controlled trial.
FIGURE 2
FIGURE 2
Network of the comparisons for the Bayesian network meta-analysis. RCT = randomized controlled trial.
FIGURE 3
FIGURE 3
Funnel plot of this network meta-analysis. C = conservative treatment, I = intramedullary pin fixation, P = plate fixation.
FIGURE 4
FIGURE 4
Inconsistency plot of this network meta-analysis. C = conservative treatment, I = intramedullary pin fixation, IFs = inconsistency factors, P = plate fixation.
FIGURE 5
FIGURE 5
Odd ratios with 95% confidence intervals for nonunion and infection.
FIGURE 6
FIGURE 6
Surface under the cumulative ranking curves for nonunion.
FIGURE 7
FIGURE 7
Ranking of treatments in terms of nonunion and infection.
FIGURE 8
FIGURE 8
Surface under the cumulative ranking curves for infection.
See this image and copyright information in PMC

References

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