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. 2021 Apr 14:17:261-266.
doi: 10.1016/j.jcot.2021.03.024. eCollection 2021 Jun.

Outcomes and complications after dual plate vs. single plate fixation of displaced mid-shaft clavicle fractures: A systematic review and meta-analysis

Daniel Z You  1   2 , Halli Krzyzaniak  3 , Joseph K Kendal  1   2 , C Ryan Martin  1   2 , Prism S Schneider  1   2
Affiliations

Outcomes and complications after dual plate vs. single plate fixation of displaced mid-shaft clavicle fractures: A systematic review and meta-analysis

Daniel Z You et al. J Clin Orthop Trauma. .

Erratum in

  • Erratum regarding previously published articles.
    [No authors listed] [No authors listed] J Clin Orthop Trauma. 2021 Jul 30;20:101538. doi: 10.1016/j.jcot.2021.101538. eCollection 2021 Sep. J Clin Orthop Trauma. 2021. PMID: 34405083 Free PMC article.

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.

Keywords: Clavicle fracture; Dual plate fixation; Fracture union; Orthogonal plate fixation; Orthopaedic trauma.

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Figures

Fig. 1
Fig. 1
PRISMA flow diagram.
Fig. 2
Fig. 2
Post-operative radiographs demonstrating: A) superiorly placed 3.5 mm pre-contoured plate fixation for displaced mid-shaft clavicle fractures and; B) dual plate technique with a 2.4-mm LCP superior plate and 2.7-mm reconstruction anterior plate.
Fig. 3
Fig. 3
Comparison of mid-shaft clavicle fracture implant removal rates between single plate fixation and dual mini-fragment plate fixation.
Fig. 4
Fig. 4
Comparison of mid-shaft clavicle fracture non-union rates between single plate fixation and dual plate fixation.
See this image and copyright information in PMC

References

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