Purpose:Surgical management of the lateral end of clavicle fractures has been a challenge for orthopedicsurgeons considering the high rate of non-union.There has been no right and wrong answer to thesetypes of fractur...Purpose:Surgical management of the lateral end of clavicle fractures has been a challenge for orthopedicsurgeons considering the high rate of non-union.There has been no right and wrong answer to thesetypes of fractures and many methods discussed in the literature,but the 2 most used bony proceduresare hook plate and locking plate with or without the use of supplementary soft tissue procedures.Theavailable evidence,in this case,is scarce with questionable reliability.The idea of this systemic review isto promote evidence-based practice when choosing between the 2 implants for this fracture.This studyaims to review the results by performing a systemic review of the literature comparing the results oflocking plate vs.hook plate for the lateral end of clavicle fracturefixation with an emphasis on outcomeand associated complications.Methods:A search of the literature was made with the keyword“clavicle”in PubMed/Ovid Medline/Embase and University of Edinburgh online library“discover Ed”.A total of 4063 articles were identifiedincluding case series(with at least 3 cases)and review articles focusing on locking plate alone,com-parisons of locking plate and hook plate,or hook plate alone.Articles were excluded if they were notpublished in English,focused on pediatric studies,or consisted only of book chapters.Studies examiningtension band wiring,soft tissue procedures for fracturefixation,arthroscopic-assisted procedures,additional soft tissue procedures along with platefixation,and fracture dislocation of the lateral end ofthe clavicle were also excluded.The search was then narrowed down to 21 articles after consideration ofinclusion and exclusion criteria.A detailed review of the surgical methodology further excluded addi-tional soft tissue procedures,resulting in afinal selection of 15 studies.The quality of the studies wasassessed using the Modified Coleman Score by the authors.Results:A total of 15 studies related to Neer type II fracture met the inclusion criteria.However,2 otherstudies also included type V fracture as well.The mean age of patients in these studies was 32 years.Themean follow-up period was 24.3 months(ranging from 6 to 65 months).The time of radiological unionwas documented from 2 to 4.5 months.Constant and disabilities of arm,shoulder,and hand scores weremost used as the criteria for patient outcomes.The size of the lateral fragment that can accommodate/provide bicortical fracture was documented in only 3 studies.The mean incidence of removal of hookplate was 86.9%.In contrast,the mean incidence of removal of locking plate was 27.0%.Superficial woundinfection was documented in 5 studies and deep wound infection was seen in 1 study.The mean unionrate for hook plate was 97.0%compared to 100%for locking plate.Complications associated with hookplate have been documented in 11 studies.The most commonly reported incidence of complication wasacromial osteolysis.The quality of studies was assessed using modified Coleman score.Other than 2studies that were considered for the study that met the“fair”standard all of them were considered“poor”based on the modified Coleman score.Conclusion:Both hook plate and locking plate provide acceptable operative treatment options for thelateral end of clavicle fracture.However,a consideration of surgeons’experience,the likelihood of a second operation,and the size of the lateral fragment should be considered when choosing between the 2types of implants.展开更多
文摘Purpose:Surgical management of the lateral end of clavicle fractures has been a challenge for orthopedicsurgeons considering the high rate of non-union.There has been no right and wrong answer to thesetypes of fractures and many methods discussed in the literature,but the 2 most used bony proceduresare hook plate and locking plate with or without the use of supplementary soft tissue procedures.Theavailable evidence,in this case,is scarce with questionable reliability.The idea of this systemic review isto promote evidence-based practice when choosing between the 2 implants for this fracture.This studyaims to review the results by performing a systemic review of the literature comparing the results oflocking plate vs.hook plate for the lateral end of clavicle fracturefixation with an emphasis on outcomeand associated complications.Methods:A search of the literature was made with the keyword“clavicle”in PubMed/Ovid Medline/Embase and University of Edinburgh online library“discover Ed”.A total of 4063 articles were identifiedincluding case series(with at least 3 cases)and review articles focusing on locking plate alone,com-parisons of locking plate and hook plate,or hook plate alone.Articles were excluded if they were notpublished in English,focused on pediatric studies,or consisted only of book chapters.Studies examiningtension band wiring,soft tissue procedures for fracturefixation,arthroscopic-assisted procedures,additional soft tissue procedures along with platefixation,and fracture dislocation of the lateral end ofthe clavicle were also excluded.The search was then narrowed down to 21 articles after consideration ofinclusion and exclusion criteria.A detailed review of the surgical methodology further excluded addi-tional soft tissue procedures,resulting in afinal selection of 15 studies.The quality of the studies wasassessed using the Modified Coleman Score by the authors.Results:A total of 15 studies related to Neer type II fracture met the inclusion criteria.However,2 otherstudies also included type V fracture as well.The mean age of patients in these studies was 32 years.Themean follow-up period was 24.3 months(ranging from 6 to 65 months).The time of radiological unionwas documented from 2 to 4.5 months.Constant and disabilities of arm,shoulder,and hand scores weremost used as the criteria for patient outcomes.The size of the lateral fragment that can accommodate/provide bicortical fracture was documented in only 3 studies.The mean incidence of removal of hookplate was 86.9%.In contrast,the mean incidence of removal of locking plate was 27.0%.Superficial woundinfection was documented in 5 studies and deep wound infection was seen in 1 study.The mean unionrate for hook plate was 97.0%compared to 100%for locking plate.Complications associated with hookplate have been documented in 11 studies.The most commonly reported incidence of complication wasacromial osteolysis.The quality of studies was assessed using modified Coleman score.Other than 2studies that were considered for the study that met the“fair”standard all of them were considered“poor”based on the modified Coleman score.Conclusion:Both hook plate and locking plate provide acceptable operative treatment options for thelateral end of clavicle fracture.However,a consideration of surgeons’experience,the likelihood of a second operation,and the size of the lateral fragment should be considered when choosing between the 2types of implants.
