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

2021 ◽  
Vol 17 ◽  
pp. 261-266
Author(s):  
Daniel Z. You ◽  
Halli Krzyzaniak ◽  
Joseph K. Kendal ◽  
C. Ryan Martin ◽  
Prism S. Schneider
Keyword(s):  
Systematic Review ◽  
Plate Fixation ◽  
Meta Analysis ◽  
Single Plate ◽  
Dual Plate ◽  
Clavicle Fractures

scholarly journals Are two plates better than one? A systematic review of dual plating for acute midshaft clavicle fractures

2021 ◽  
pp. 175857322110024
Author(s):  
Ujash Sheth ◽  
Claire E Fernandez ◽  
Allison M Morgan ◽  
Patrick Henry ◽  
Diane Nam
Keyword(s):  
Systematic Review ◽  
Plate Fixation ◽  
Pooled Analysis ◽  
Hardware Removal ◽  
Single Plate ◽  
Patient Reported ◽  
Dual Plating ◽  
Dual Plate ◽  
Clavicle Fractures ◽  
Operative Fixation

Background The rate of operative fixation of acute midshaft clavicle fractures has exponentially increased in recent years; however, the rate of reoperation for symptomatic hardware removal remains high and the optimal fixation strategy unknown. This systematic review aimed to summarize available evidence for dual plating of acute displaced midshaft clavicle fractures. Methods EMBASE, MEDLINE, and PubMed searches identified clinical studies evaluating dual plate fixation of acute midshaft clavicle fractures. Pooled analysis was performed using a random-effects model in RevMan 5.3. Results Eleven studies including 672 patients were included. Hardware removal occurred in 4.4% and 12.3% of patients undergoing dual and single plate fixation, respectively. Compared to single plating, dual plating had significantly lower odds of hardware removal ( P = 0.001) with no difference in union rates. There were no significant differences in reoperation (excluding hardware removal), complications, and patient-reported outcomes between the two groups ( P > 0.05). Conclusions This study suggests that dual plating of acute displaced midshaft clavicle fractures may lead to lower rates of reoperation for symptomatic hardware removal without compromising fracture healing. Ultimately, well-designed randomized trials are needed to further investigate the findings from this systematic review.

scholarly journals Management of comminuted mid-shaft clavicular fractures: Comparison between dual-plate fixation treatment and single-plate fixation

2020 ◽  
Vol 28 (2) ◽  
pp. 230949902091579
Author(s):  
Yunqiang Zhuang ◽  
Yadi Zhang ◽  
Long Zhou ◽  
Jun Zhang ◽  
Gangqiang Jiang ◽  
...  
Keyword(s):  
Plate Fixation ◽  
Bony Union ◽  
Single Plate ◽  
Significant Difference ◽  
Dual Plating ◽  
Fixation Treatment ◽  
Dual Plate ◽  
Clavicle Fractures ◽  
Group B ◽  
The Comparative Study

Background: We consider dual-plate fixation to improve construct rigidity in cases with fracture complexity. The purpose of this study is to compare the rate of nonunion, prognosis, and complications at 6–12 months for surgically treated acute mid-shaft clavicle fractures when extra-periosteal dual-plate fixation is used in place of the conventional single-plate fixation. Materials and Methods: The comparative study was conducted on 47 patients who received acute mid-shaft clavicular fracture treatment in our hospital from March 2015 to July 2018. All patients were divided into dual-plate fixation treatment (group A) and single-plate fixation (group B). Patients undergoing single-plate fixation were compared to dual-plate fixation. Patients were followed up for 6–12 months. Charts were reviewed to assess union rates, prognosis, and complications. Results: Forty-seven clavicles (30 single plates and 17 dual plates) were evaluated. All patients (100%) in dual plating group and 128 (93.3%) in single plating group obtained bony union by 1 year. When comparing groups at 3 months, radiographic union was present in 50.0% of single plates and 64.7% in the dual plating group ( p = 0.032). However, at 6 months, no significant difference existed (90.0% vs. 94.1%, p = 0.297). Comparing groups at 1.5 and 6 months, Constant–Murley outcome scores were present with no significant difference ( p = 0.129, p = 0.054) between single plates and dual plating group. However, at 3 months, significance difference existed. Discussion: Three months after the operation, patients with dual-plate fixation showed good functional recovery. Extra-periosteal dual plating for acute mid-shaft clavicle fractures can be safely considered for the treatment of complex acute mid-shaft clavicle fractures without increasing the risk of nonunion or revision. Conclusions: Open reduction and internal fixation with an extra-periosteal dual plating technique is a reliable option for treatment of acute mid-shaft clavicle fractures, especially in the setting of severely comminuted fractures and in situations where bone quality is questionable and additional fixation is desired.

Arthrodesis of First Metatarsophalangeal Joint by Plate and Screws for Treatment of Hallux Rigidus (Systematic Review and Meta-Analysis)

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ossama Abdelraoof El Shazly ◽  
Mohamed Mokhtar Abdellah ◽  
Mostafa Abdelnabee Abouzaid
Keyword(s):  
Systematic Review ◽  
Observational Studies ◽  
Plate Fixation ◽  
Meta Analysis ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
Superficial Infection ◽  
First Metatarsophalangeal Joint ◽  
Non Union ◽  
Meta Analyses

Abstract Background With continued loss of dorsiflexion of the 1st MTP, degenerative changes occur within the joint with severe restriction of movement and increase in pain, which leads to the condition known as hallux rigidus. The amount of dorsiflexion may be reduced to 0-10 degrees with pain on both active and passive motion. Objectives Systematically reviewing available evidence from published articles to assess the effectiveness of arthrodesis of first metatarsophalangeal joint by plate and screws in hallux rigidus. The assessment also would encompass safety, side effects, and complications of this mode of treatment. Materials and Methods We performed this systematic review and meta-analysis in accordance to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) statement. PRISMA and MOOSE are reporting checklists for Authors, Editors, and Reviewers of Meta-analyses of interventional and observational studies. According to International committee of medical journal association (ICJME), reviewers must report their findings according to each of the items listed in those checklists. Results Previous results for arthrodesis have been favourable with a union rate of almost 96%. In the present systematic review and meta-analysis, the overall effect estimates showed that the union rates after plate and screw arthrodesis for 1st MTPJ was 96.2% (95% CI 94 – 98.4%). In addition, the overall effect estimates showed that the non-union rates after plate and screw arthrodesis for 1st MTPJ was 4.2% (95% CI 2.4 – 6.1%). Moreover, the overall effect estimates showed that the satisfaction rates after plate and screw arthrodesis for 1st MTPJ was 94.5% (95% CI 90 – 99%). In the present study, the overall effect estimates showed that the overall complications rate after plate and screw arthrodesis for 1st MTPJ was 7.2% (95% CI 2.5 – 12%). The overall effect estimates showed that the malunion rates after plate and screw arthrodesis for 1st MTPJ was 2.7% (95% CI 0 – 6.4%). Additionally, the overall effect estimates showed that the hardware removal and superficial infection rates after plate and screw arthrodesis for 1st MTPJ were 2% and 2.9%, respectively. Conclusion Our analysis showed that plate and screws fixation is effective techniques that can be used for first MTPJ arthrodesis in patients with hallux rigidus. We found that the screw and plate fixation has a significantly lower rate of nonunion compared with the screw alone, as reported by the literature. However, owing to the small group sizes and methodologic shortcomings, we were unable to identify the clinically superior fixation technique for first MTPJ arthrodesis arthrodesis.

scholarly journals Functional Outcomes and Complications of Intramedullary Fixation Devices for Midshaft Clavicle Fractures: A Systematic Review and Meta-Analysis.

2020 ◽  
Author(s):  
Paul Hoogervorst ◽  
Tess van Dam ◽  
Nico Verdonschot ◽  
Gerjon Hannink
Keyword(s):  
Systematic Review ◽  
Functional Outcomes ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Intramedullary Fixation ◽  
Common Complication ◽  
Fixation Device ◽  
Operative Strategy ◽  
Fixation Devices ◽  
Clavicle Fractures

Abstract Background An alternative to the current gold standard in operative treatment of displaced midshaft clavicle fractures (DMCF) using plate osteosynthesis, is internal fixation by means of intramedullary fixation devices. These devices differ considerably in their specifications and characteristics. The aim of this systematic review is to generate an overview of functional outcomes and complications in the management of DMCF per available intramedullary device.Methods A systematic review was conducted to identify all papers reporting functional outcomes, union rates and/or complications using an intramedullary fixation device for the management of midshaft clavicle fractures. Multiple databases and trial registries were searched from inception until February 2020. Meta-analysis was conducted based on functional outcomes and type of complication per type of intramedullary fixation device. Pooled estimates of functional outcomes scores and incidence of complications were calculated using a random effects model. Risk of bias and quality was assessed using the Cochrane risk of bias and ROBINS-I tools. The confidence in estimates were rated and described according to the recommendations of the GRADE working group.Results Sixty-seven studies were included in this systematic review. The majority of studies report on the use of Titanium Elastic Nails (TEN). At 12 months follow up the Titanium Elastic Nail and Sonoma CRx report an average Constant-Murley score of 94.4 (95%CI 93-95) and 94.0 (95%CI 92-95) respectively (GRADE High). The most common reported complications after intramedullary fixation are implant-related and implant-specific. For the TEN, hardware irritation and protrusion, telescoping or migration, with a reported pooled incidence 20% (95%CI 14-26) and 12% (95%CI 8-18), are most common (GRADE Moderate). For the Rockwood/Hagie Pin, hardware irritation is identified as the most common complication with 22% (95%CI 13-35) (GRADE Low). The most common complication for the Sonoma CRx was cosmetic dissatisfaction in 6% (95%CI 2-17) of cases (GRADE Very low). Conclusion Although most studies were of low quality, good functional results and union rates irrespective of the type of device are found. However, there are clear device-related and device-specific complications for each. The results of this systematic review and meta-analysis can help guide surgeons in choosing the appropriate operative strategy, implant and informing their patient.

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