2023 ISAKOS Biennial Congress ePoster
Coraco-Clavicular Ligament Reconstruction for Displaced Distal Clavicle Fractures Has A Lower Complication Rate Than Hook Plate But Excellent Union Rate and Comparative Functional Outcome: A Systematic Review and Meta-Analysis
Mohammedabbas Remtulla, MBBS, MRCSED,PGCertMed, Birmingham UNITED KINGDOM
Shahbaz S Malik, BSc, MB BCh, MSc (Orth Engin), LLM, FRCS (Tr&Orth), Birmingham UNITED KINGDOM
Muaaz Tahir, MBBS, MRCS, Birmingham UNITED KINGDOM
Peter Alberto D'Alessandro, MBBS Hons. (UWA) FRACS FAOrthA, Claremont, WA AUSTRALIA
Sheraz Shafi Malik, MSc (Orth Engin), LLM, FRCS (Tr&Orth), London UNITED KINGDOM
Robert Jordan, MB BS, MSc, FRCS (Tr&Orth), Birmingham UNITED KINGDOM
Worcestershire Acute Hospitals NHS Trust, Worcester, Worcestershire, UNITED KINGDOM
FDA Status Not Applicable
Summary
Coraco-clavicular ligament reconstruction for displaced distal clavicle fractures has a significantly lower complication rate than hook plate but excellent union rate and comparative functional outcome
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Abstract
Purpose
The aim of this systematic review and meta-analysis is to compare the outcome of Hook plate (HP) fixation with coraco-clavicular ligament reconstruction (CCLR) in surgical fixation of displaced distal clavicle fractures
Methods
A review of the online databases MEDLINE and Embase was conducted on 15th January 2021 according to PRISMA guidelines. The review was registered prospectively in the PROSPERO database. Clinical studies reporting union rate, complications and shoulder function were included. The studies were appraised using the Methodological Index for Non-Randomized Studies (MINORS) tool and Consolidated Standards of Reporting Trials (CONSORT) checklist.
Results
The search strategy identified 47 studies eligible for inclusion with a total of 1,253 patients. These included 17 hook plate case series (n=573), 24 CCLR case series (n=368) and 6 comparative studies (n=312). The overall complication rate was significantly higher with HP when compared to CCLR [21.9% vs 9.0%; OR 3.89 (95% CI: 1.65-9.19)]. The overall union rates in the case series appeared comparable in the current SR; HP 96.4%, and CCLR 96.2%. Shoulder function was most commonly assessed using Constant-Murley (CM) score and the mean ranged from 83.8 to 97.2 in HP, 81.8 to 98.9 in CCLR. Meta-analysis of CM score failed to show a significant difference for HP versus CCLR (pooled weighted mean difference 3.68 (95% -1.02 – 8.37) with a trend to favour CCLR fixation.
Conclusion
The current review has demonstrated that HP and CCLR offer excellent union rate and appear to provide comparative functional outcomes. However, HP is associated with significantly higher complication rates with more recent CCLR techniques potentially offering comparable union rate and lower complication rates.