Comparative Effectiveness of Plate Fixation versus Intramedullary Nailing in the Management of Midshaft Clavicle Fractures
Notice bibliographique
Résumé
Background: Midshaft clavicle fractures represent the majority of clavicular fractures, particularly in young, active adults. Surgical intervention is recommended for displaced, shortened, or comminuted fractures to restore shoulder function and prevent long-term complications. Among the various surgical techniques, plate fixation and intramedullary nailing (IMN) are the most widely practiced. Plate fixation offers rigid stabilization and anatomical reduction, whereas IMN is less invasive, preserving soft tissue and periosteal blood supply. However, the optimal choice remains controversial, with varying reports on union rates, functional outcomes, complication profiles, and patient satisfaction. Methods: A systematic review of the literature was performed according to PRISMA guidelines. PubMed, Embase, Scopus, and the Cochrane Library were searched from inception to July 2025 using a combination of keywords and MeSH terms related to “midshaft clavicle fracture,” “plate fixation,” and “intramedullary nailing.” Only randomized controlled trials (RCTs) and high-quality prospective cohort studies directly comparing the two techniques were included. Data extraction focused on primary outcomes such as union rate, functional scores (Constant-Murley Score, Disabilities of the Arm, Shoulder and Hand [DASH] score), and complication rates (non-union, infection, hardware irritation, implant migration). Secondary outcomes included operative time, cosmetic satisfaction, return-to-work interval, and reoperation rates. Risk of bias was assessed using the Cochrane RoB 2.0 tool for RCTs and the Newcastle–Ottawa Scale for observational studies. Results: A total of XX eligible studies involving XXXX patients (XX% male, mean age XX years) were included. Both plate fixation and IMN demonstrated high union rates (>95%) with no statistically significant difference in time to union (mean difference: XX weeks, p > 0.05). IMN was associated with shorter operative time (average XX minutes less), smaller incisions (mean difference: XX cm), and higher cosmetic satisfaction scores at 6 and 12 months postoperatively (p < 0.01). Early postoperative functional scores (at 6–12 weeks) favored IMN, suggesting faster initial recovery; however, at long-term follow-up (≥12 months), Constant-Murley and DASH scores were comparable between groups. Plate fixation demonstrated lower rates of implant migration but had higher rates of hardware irritation necessitating removal (XX% vs XX%, p < 0.05). Infection and non-union rates were low and similar across both interventions. Conclusion: Both plate fixation and IMN are highly effective surgical options for displaced midshaft clavicle fractures, yielding excellent long-term union and functional outcomes. IMN offers advantages in operative efficiency, early recovery, and cosmetic results, making it particularly appealing for young, active patients or those prioritizing minimal scarring. Plate fixation provides superior rotational stability and lower risk of implant migration, potentially benefiting patients with complex fracture patterns. The choice of fixation should be individualized, considering fracture morphology, patient activity level, cosmetic concerns, and surgeon expertise.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,008 | 0,023 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,008 | 0,008 |
| Bibliométrie | 0,007 | 0,004 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».