Comparative clinical efficacy of anatomic plate and Kirschner wire internal fixation in midshaft clavicle fractures: A meta-analysis

Midshaft (mid)-clavicle fractures are the most common type of clavicle fractures. The Kirschner wire (KW) and anatomic plate (AP) are two commonly used surgical treatment methods for mid-clavicle fractures, of which the use of an AP appears to be a more effective option. The present study performed a meta-analysis of a number of published studies on the treatment of mid-clavicle fractures with APs and KWs, in order to compare the advantages and disadvantages of the two treatments, so as to select a more effective treatment approach. The articles were obtained from several databases, including Cochrane Library, PubMed, Embase, CNKI, Wanfang, VIP and Chinese Biomedical Literature Database. The search period was from database establishment to June, 2021. Research was obtained by two authors who individually searched the aforementioned databases. For controversial studies, decisions were made by two authors (JZ and LW). A total of 20 studies involving 1,739 patients were included in the meta-analysis, including eight randomized controlled studies and 12 cohort trials. The results of the meta-analysis suggested that: Compared with the KW group, the AP group exhibited significant differences in incision length [standardized mean difference (SMD)=2.40; 95% confidence interval (CI), 1.93-2.86], constant function score (6 months; SMD=1.59; 95% CI, 1.29-1.89) and fracture healing time (SMD=-1.48; 95% CI, -2.09 to -0.87) (P<0.05). However, no significant differences were observed in the duration of the surgery (SMD=1.19; 95% CI, -0.19-2.57) and intraoperative blood loss (SMD=0.10; 95% CI, -3.13-3.32) (P>0.05). Compared with the KW group, significant differences were observed in post-operative efficacy (OR, 4.81; 95% CI, 3.10-7.46) and the incidence of post-operative complications (OR, 0.16; 95% CI, 0.05-0.55) in the AP group (P<0.05). On the whole, the AP and KW are two common materials for the clinical surgical treatment of mid-clavicle fractures. The present study confirmed that there was no significant difference between the two treatments as regards the duration of surgery and intraoperative blood loss; however, for post-operative shoulder joint function recovery, fracture healing state and healing time, the AP was significantly more effective than the KW. The post-operative complication rate of the AP group was significantly lower than that of the KW group. However, further prospective, large-sample randomized controlled studies are required to provide more concrete evidence for verification.