Plating versus intramedullary pin or conservative treatment for midshaft fracture of clavicle: a meta-analysis of randomized controlled trials

Hypothesis: Clavicular fractures account for 2% to 2.6% of all fractures. Plating has been considered the gold standard for treating midshaft clavicular fracture. Intramedullary pinning and conservative treatments have also been commonly used. We hypothesized that intramedullary pinning and conservative treatments have the same treatment results compared with plating. Methods: To evaluate the effect of plating vs intramedullary pinning or conservative treatment for midshaft clavicular fracture, the Cochrane Central Register of Controlled Trials (CENTRAL; Wiley Online Library, October 2010), PubMed (1950 to October 2010), and EMBASE (1980 to October 2010) were searched. Randomized and quasi-randomized controlled clinical studies evaluating plating vs intramedullary pinning or plating vs conservative treatment for midshaft clavicular fracture in adults were collected. After independent study selection by 2 authors, data were collected and extracted independently. The methodologic quality of the studies was assessed. Pooling of data was undertaken. Results: Four studies involving 305 clavicular fractures were included. There were no significant differences between plating and intramedullary pinning with regard to outcome for Oxford Shoulder Score, Constant Shoulder Score, nonunion, infection, fixation failure, and hardware removal. More symptomatic hardware events occurred with plating compared with intramedullary pinning. Reduced nonunion, malunion, and neurologic symptoms, as well as more satisfaction with ultimate appearance, were associated with plating than with conservative treatment. Discussion: This meta-analysis supports the treatment effects reported previously with plating for midshaft clavicular fractures. The outcome of this meta-analysis contradicted the findings reported previously with conservative treatment for midshaft clavicular fractures. Conclusion: The available evidence suggests that there are no differences in treatment effects between plating and intramedullary pinning, but plating is associated with more side effects. Plating is associated with improved treatment effects when compared with conservative treatment. Level of evidence: Level II, Meta-Analysis. (C) 2011 Journal of Shoulder and Elbow Surgery Board of Trustees.