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

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.