Vautrin M, Kaminski G, Barimani B, Elmers J, Philippe V, Cherix S, Thein E, Borens O, Vauclair F
Orthopedic Trauma Surgery Unit, Department of the Locomotor Apparatus, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
UMR 5263, Laboratoire CLLE-LTC, Toulouse, France.
Shoulder Elbow. 2019 Feb;11(1):9-16. doi: 10.1177/1758573218777996. Epub 2018 Jun 4.
The hypothesis of this study was that patient selection for midshaft clavicle fracture (open reduction internal fixation with plate conservative) would give better functional outcome than random treatment allocation.
We performed a systematic literature search for primary studies providing functional score and non-union rate after conservative or surgical management of midshaft clavicle fractures. Six randomized controlled trial and 19 non-randomized controlled trial studies encompassing a total of 1348 patients were included.
Patients treated with surgical management were found to have statistically superior Constant scores in non-randomized controlled trials than in randomized controlled trials (94.76 ± 6.4 versus 92.49 ± 6.2; p < 0.0001). For conservative treatment, randomized controlled trials were found to have significantly better functional outcome. The prevalence of non-union (6.1%) did not show significant statistical difference between non-randomized controlled trial and randomized controlled trial studies. The functional outcome after surgical management was significantly higher than after conservative management in both randomized controlled trial and non-randomized controlled trial groups. The non-union rate after surgery (1.1% for both non-randomized controlled trial and randomized controlled trial) was significantly lower than following conservative treatment (9.9% non-randomized controlled trial versus 15.1% randomized controlled trial).
This review shows that patient selection for surgery may influence functional outcome after midshaft clavicle fracture. Our results also confirm that plate fixation provides better functional outcome and lower non-union rate.
本研究的假设是，对于中段锁骨骨折（钢板切开复位内固定 保守治疗），患者选择治疗比随机分配治疗能带来更好的功能结局。
我们对关于中段锁骨骨折保守或手术治疗后功能评分和骨不连发生率的原始研究进行了系统的文献检索。纳入了6项随机对照试验和19项非随机对照试验研究，共涉及1348例患者。
在非随机对照试验中，接受手术治疗的患者的Constant评分在统计学上优于随机对照试验中的患者（94.76±6.4对92.49±6.2；p<0.0001）。对于保守治疗，随机对照试验的功能结局明显更好。非随机对照试验和随机对照试验研究之间骨不连的发生率（6.1%）没有显著的统计学差异。在随机对照试验组和非随机对照试验组中，手术治疗后的功能结局均显著高于保守治疗后的功能结局。手术后的骨不连发生率（非随机对照试验和随机对照试验均为1.1%）显著低于保守治疗后的发生率（非随机对照试验为9.9%，随机对照试验为15.1%）。
本综述表明，手术患者的选择可能会影响中段锁骨骨折后的功能结局。我们的结果还证实，钢板固定可提供更好的功能结局和更低的骨不连发生率。
