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Interventions for Treating Displaced Midshaft Clavicular Fractures: A Bayesian Network Meta-Analysis of Randomized Controlled Trials

Displaced midshaft clavicle fractures are frequent injuries. There are 3 treatment methods including conservative treatment, plate fixation, and intramedullary pin fixation. However, which is the best treatment remains a topic of debate. To establish the optimum treatment for displaced midshaft clav...

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Autores principales: Wang, Jia, Meng, Xiao-Hui, Guo, Zhi-Ming, Wu, Ying-Hua, Zhao, Jia-Guo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4602486/
https://www.ncbi.nlm.nih.gov/pubmed/25789948
http://dx.doi.org/10.1097/MD.0000000000000595
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author Wang, Jia
Meng, Xiao-Hui
Guo, Zhi-Ming
Wu, Ying-Hua
Zhao, Jia-Guo
author_facet Wang, Jia
Meng, Xiao-Hui
Guo, Zhi-Ming
Wu, Ying-Hua
Zhao, Jia-Guo
author_sort Wang, Jia
collection PubMed
description Displaced midshaft clavicle fractures are frequent injuries. There are 3 treatment methods including conservative treatment, plate fixation, and intramedullary pin fixation. However, which is the best treatment remains a topic of debate. To establish the optimum treatment for displaced midshaft clavicular fractures, we did a network meta-analysis to compare 3 treatments in terms of postoperative nonunion and infection. We searched PubMed, the Cochrane Library, and Embase for relevant randomized controlled trials (RCTs) until the end of October 2014. Two investigators independently reviewed the abstract and full text of eligible studies and extracted information. We used WinBUGS 1.4 (Imperial College School of Medicine at St Mary's, London) to perform our Bayesian network meta-analysis. We used the graphical tools in STATA12 (StataCorp, Texas) to present the results of statistical analyses of WinBUGS14. Nonunion and infection were presented as odd ratios (ORs) with 95% confidence intervals (CIs). We also presented the results using surface under the cumulative ranking curve (SUCRA). A higher SUCRA value suggests better results for respective treatment method. Thirteen RCTs were included in our network meta-analysis, with a total of 894 patients randomized to receive 1 of 3 treatments. Nonunion rates were 0.9%, 2.4%, and 11.4% for intramedullary pin fixation, plate fixation, and conservative method, respectively. Nonunion occurred more commonly in patients treated with conservative method than in patients treated with either plate fixation (OR, 0.18; 95% CI, 0.05–0.46) or intramedullary pin fixation (OR, 0.12; 95% CI, 0.01–0.50). There was no significant difference between plate and intramedullary pin fixation in nonunion (OR, 3.64; 95% CI, 0.31–17.27). Furthermore, SUCRA probabilities were 87.8%, 62.0%, and 0.2% for intramedullary pin fixation, plate fixation, and conservative method, respectively. Infection rates were 3.6% and 3.9% for intramedullary pin fixation and plate fixation, respectively. There was no significant difference between plate and intramedullary pin fixation in infection (OR, 3.64; 95% CI, 0.31–17.27). SUCRA probabilities were 46.5% and 8.5% for intramedullary pin and plate fixation, respectively. Our network meta-analysis suggested that intramedullary pin fixation is the optimum treatment method for displaced midshaft clavicle fracture because of the low probabilities of nonunion and infection.
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spelling pubmed-46024862015-10-27 Interventions for Treating Displaced Midshaft Clavicular Fractures: A Bayesian Network Meta-Analysis of Randomized Controlled Trials Wang, Jia Meng, Xiao-Hui Guo, Zhi-Ming Wu, Ying-Hua Zhao, Jia-Guo Medicine (Baltimore) 7100 Displaced midshaft clavicle fractures are frequent injuries. There are 3 treatment methods including conservative treatment, plate fixation, and intramedullary pin fixation. However, which is the best treatment remains a topic of debate. To establish the optimum treatment for displaced midshaft clavicular fractures, we did a network meta-analysis to compare 3 treatments in terms of postoperative nonunion and infection. We searched PubMed, the Cochrane Library, and Embase for relevant randomized controlled trials (RCTs) until the end of October 2014. Two investigators independently reviewed the abstract and full text of eligible studies and extracted information. We used WinBUGS 1.4 (Imperial College School of Medicine at St Mary's, London) to perform our Bayesian network meta-analysis. We used the graphical tools in STATA12 (StataCorp, Texas) to present the results of statistical analyses of WinBUGS14. Nonunion and infection were presented as odd ratios (ORs) with 95% confidence intervals (CIs). We also presented the results using surface under the cumulative ranking curve (SUCRA). A higher SUCRA value suggests better results for respective treatment method. Thirteen RCTs were included in our network meta-analysis, with a total of 894 patients randomized to receive 1 of 3 treatments. Nonunion rates were 0.9%, 2.4%, and 11.4% for intramedullary pin fixation, plate fixation, and conservative method, respectively. Nonunion occurred more commonly in patients treated with conservative method than in patients treated with either plate fixation (OR, 0.18; 95% CI, 0.05–0.46) or intramedullary pin fixation (OR, 0.12; 95% CI, 0.01–0.50). There was no significant difference between plate and intramedullary pin fixation in nonunion (OR, 3.64; 95% CI, 0.31–17.27). Furthermore, SUCRA probabilities were 87.8%, 62.0%, and 0.2% for intramedullary pin fixation, plate fixation, and conservative method, respectively. Infection rates were 3.6% and 3.9% for intramedullary pin fixation and plate fixation, respectively. There was no significant difference between plate and intramedullary pin fixation in infection (OR, 3.64; 95% CI, 0.31–17.27). SUCRA probabilities were 46.5% and 8.5% for intramedullary pin and plate fixation, respectively. Our network meta-analysis suggested that intramedullary pin fixation is the optimum treatment method for displaced midshaft clavicle fracture because of the low probabilities of nonunion and infection. Wolters Kluwer Health 2015-03-20 /pmc/articles/PMC4602486/ /pubmed/25789948 http://dx.doi.org/10.1097/MD.0000000000000595 Text en Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. http://creativecommons.org/licenses/by-nc-sa/4.0
spellingShingle 7100
Wang, Jia
Meng, Xiao-Hui
Guo, Zhi-Ming
Wu, Ying-Hua
Zhao, Jia-Guo
Interventions for Treating Displaced Midshaft Clavicular Fractures: A Bayesian Network Meta-Analysis of Randomized Controlled Trials
title Interventions for Treating Displaced Midshaft Clavicular Fractures: A Bayesian Network Meta-Analysis of Randomized Controlled Trials
title_full Interventions for Treating Displaced Midshaft Clavicular Fractures: A Bayesian Network Meta-Analysis of Randomized Controlled Trials
title_fullStr Interventions for Treating Displaced Midshaft Clavicular Fractures: A Bayesian Network Meta-Analysis of Randomized Controlled Trials
title_full_unstemmed Interventions for Treating Displaced Midshaft Clavicular Fractures: A Bayesian Network Meta-Analysis of Randomized Controlled Trials
title_short Interventions for Treating Displaced Midshaft Clavicular Fractures: A Bayesian Network Meta-Analysis of Randomized Controlled Trials
title_sort interventions for treating displaced midshaft clavicular fractures: a bayesian network meta-analysis of randomized controlled trials
topic 7100
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4602486/
https://www.ncbi.nlm.nih.gov/pubmed/25789948
http://dx.doi.org/10.1097/MD.0000000000000595
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