Meta-analysis on middle clavicle fracture treated with Ortho-Bridge System and locking plate

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Locking plate is the most commonly used method for the treatment of middle clavicle fracture at present. Ortho-Bridge System is a new type of internal fixation device, which has not been used for a long time. However, many domestic scholars have published many clinical studies to compare the efficacy of the two, but there is no unified opinion. This study compared the efficacy of Ortho-Bridge System and locking plate in the treatment of middle clavicle fracture by meta-analysis. 
METHODS: A computer-based online search was conducted in PubMed, Medline, The Cochrane Library, MSTC FMRS foreign medical information platform, Ovid Medical Journal Full-text Database, VIP, CNKI, Wanfang digital journal and other platforms to collect the randomized controlled trials published from January 2010 to April 2020 on the treatment of middle clavicular fracture with the combination of Ortho-Bridge System and locking plate. According to the inclusion and exclusion criteria, Jadad scale and MINORS scale were used to evaluate the quality of the included articles. After quality evaluation and data extraction, the operation time, intraoperative blood loss, fracture healing time, complications and 1-year postoperative shoulder joint function score were selected as the evaluation indicators for meta-analysis. The results of the included studies were meta analyzed by RevMan 5.2 software provided by Cochrane Collaboration Network.
RESULTS: (1) A total of nine Chinese and foreign articles were included in this study, including three randomized controlled trials and six non randomized controlled trials. A total of 613 patients with middle clavicle fractures were included, including 280 cases in the Ortho-Bridge System group and 333 cases in the locking plate group. (2) Meta-analysis results showed that there was no significant difference in postoperative shoulder function (MD=3.23, 95%CI:0.13-6.33, P=0.04). However, the Ortho-Bridge System group was better than the locking plate group in operation time (MD=-4.62, 95%CI:-9.08 to -0.16, P=0.04), intraoperative blood loss (MD=-15.29, 95%CI:-15.81 to -14.47, P < 0.000 01), fracture healing time (MD=-2.88, 95%CI:-3.10 to -2.65, P < 0.000 01), and overall complications (OR=0.21, 95%CI:0.09-0.48, P=0.000 2).
CONCLUSION: Ortho-Bridge System and locking plate can achieve the expected results in the treatment of mid clavicle fracture. There was no significant difference in shoulder function between the two methods. In terms of operation time, intraoperative blood loss, fracture healing time and overall complications, Ortho-Bridge System has certain advantages over locking plate. However, due to the influence of methodological quality of this study, the results need to be treated with caution, and more large sample and multi center randomized controlled trials are needed to confirm.


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M.B.B.S; M.S (Orthopedic); M.P.H

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