Klavikula kırığına yapılan cerrahi vecerrahi dışı girişimlerin değerlendirilmesi

Year 2014, Volume: 48 Issue: 3, 253 - 258, 30.05.2014

Shengping Yang Rui Zhang Qingling Zhu Guan Wang Xuanxi Ding Jianmin Wang

https://doi.org/10.3944/AOTT.2014.3240

Abstract

Amaç:Bu çalışmanın amacı, tüm sistematik inceleme ve meta-analizleri gözden geçirmek ve klavikula kırıklarına yapılan girişimlerin etkinliğini kanıtlayan bir özet sunmak idi.

Çalışma planı: Cochrane Library, PubMed, MEDLINE, Chinese BioMedicine veri tabanı, Çin Akademik Dergiler Tam Metin (China Academic Journals Full-text) Veri Tabanı, VIP Çin Bilim ve Teknoloji Süreli Yayınlar (Chinese Science and Technology Periodicals) Veri Tabanı ve Wanfang Veri Tabanı klavikula kırıklarıyla ilgili anahtar sözcükler kullanılarak, uygun çalışmalar için tarandı. Çalışmaya dahil edilen çalışmaların metodolojik kalitesi AMSTAR değerlendirme aracı kullanılarak değerlendirildi. Direkt kanıtlar anlatı analizi ile incelendi. Randomize kontrollü çalışmalar meta-analiz için tekrar havuzda toplandı. Özet sonuçlarında GRADE yaklaşımı kullanıldı.

Bulgular: Toplanan verilerin sonuçları cerrahi girişimin cerrahi dışı girişimlere yöntemlerine göre daha az kaynamama ve hatalı kaynama ile daha yüksek hasta memnuniyeti sağladığını [RO=6.57, %95 GA (3.01, 14.35), RO=6.93, %95 GA (2.99, 16.09); RO=0.68, %95 GA (0.51, 0.90)] gösterdiği halde, bu 3 sonuç düşük kaliteli kanıtlara dayanmaktaydı. Farklı cerrahi ve cerrahi dışı yöntemler arasında bir fark saptanmadı.

Çıkarımlar: Cerrahi girişim, kaynamama ve hatalı kaynama oranları ile hasta memnuniyeti açısından cerrahi dışı girişime göre daha etkili bir yaklaşımdır. Girişim yöntemlerinin etkinliğini karşılaştıran kanıt kalitesi genel olarak düşük olduğundan, bu konuda daha fazla orijinal çalışmaya ihtiyaç vardır.

Keywords

Cerrahi dışı girişim; cerrahi girişim; klavikula kırığı; GRADE; incelemelerin özeti; sistematik inceleme.

Evaluation of surgical and non-surgical interventions for clavicle fractures

Abstract

Objective:The aim of this study was to review all systematic reviews and meta-analyses and provide an overview of the evidence of efficacy of interventions for clavicle fractures.

Methods: The Cochrane Library, PubMed, MEDLINE, Chinese Biomedicine database, China Academic Journals Full-text Database, VIP Chinese Science and Technology Periodicals Database and Wanfang Database were searched for eligible studies using keywords related to clavicle fractures. The methodological quality of included studies was assessed using the AMSTAR assessment tool. Direct evidence was analyzed narratively. Randomized controlled trials were pooled again for meta-analysis. The GRADE approach was used in summary conclusions.

Results: The result of pooled data showed that while operative treatment had lower nonunion and malunion rates and higher patient satisfaction than non-operative treatment modalities [RR=6.57, 95% CI (3.01, 14.35), RR=6.93, 95% CI (2.99, 16.09); RR=0.68, 95% CI (0.51, 0.90)], these 3 outcomes were based on low-quality evidence. There was no difference between dissimilar operative and dissimilar non-operative treatments.

Conclusion: Operative treatment is more effective than non-operative treatment in terms of nonunion and malunion rates and patient satisfaction. As the quality of evidence comparing efficacy between intervention methods is generally low, further original studies are needed.

Keywords

Clavicle fracture, GRADE, non-operative treatment, operative treatment, overview of reviews, systematic review

References

• Postacchini F, Gumina S, De Santis P, Albo F. Epidemiology of clavicle fractures. J Shoulder Elbow Surg 2002;11:452-6.
• Stanley D, Trowbridge EA, Norris SH. The mechanism of clavicular fracture. A clinical and biomechanical analysis. J Bone Joint Surg Br 1988;70:461-4.
• Nordqvist A, Petersson C. The incidence of fractures of the clavicle. Clin Orthop Relat Res 1994;300:127-32.
• Chalidis B, Sachinis N, Samoladas E, Dimitriou C, Christodoulou A, Pournaras J. Acute management of clavicle fractures. A long term functional outcome study. Acta Orthop Belg 2008;74:303-7.
• Bisbinas I, Mikalef P, Gigis I, Beslikas T, Panou N, Christoforidis I. Management of distal clavicle fractures. Acta Orthop Belg 2010;76:145-9.
• Kao FC, Chao EK, Chen CH, Yu SW, Chen CY, Yen CY. Treatment of distal clavicle fracture using Kirschner wires and tension-band wires. J Trauma 2001;51:522-5.
• Liu Q, Miao J, Lin B, Lian K. Surgical treatment for unstable distal clavicle fracture with micromovable and anatomical acromioclavicular plate. Int J Med Sci 2012;9:301-5. van der Meijden OA, Gaskill TR, Millett PJ. Treatment of clavicle fractures: current concepts review. J Shoulder Elbow Surg 2012;21:423-9.
• Guyatt GH, Oxman AD, Kunz R, Vist GE, Falck-Ytter Y, Schünemann HJ. What is “quality of evidence” and why is it important to clinicians? BMJ 2008;336:995-8.
• Lenza M, Buchbinder R, Johnston RV, Belloti JC, Faloppa F. Surgical versus conservative interventions for treating fractures of the middle third of the clavicle. Cochrane Database Syst Rev 2013;6:CD009363.
• McKee RC, Whelan DB, Schemitsch EH, Hu K. Midshaft clavicular fractures: operative versus nonoperative treatment. [Article in Chinese] J Clin Orthop 2012;02:191.
• Zhang J, Gu G. Comparison between the operative and nonoperative treatment of the clavicle fracture. [Article in Chinese] Changchun: Jilin Univesity; 2008.
• Felder-Puig R, Mathis S, Pelinka H, Mittermayr T, Pieske O. Midshaft clavicle fractures: A systematic review of different treatment approaches. [Article in German] Unfallchirurg 2011;114:987-97. [Abstract]
• Virtanen K, Remes V, Malmivaara A, Paavola M. Treatment of clavicle fractures: systematic review. Suomen Ortopedia ja Traumatologia 2009;32:134-9.
• Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD; Evidence-Based Orthopaedic Trauma Working Group. Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the Evidence-Based
• Orthopaedic Trauma Working Group. J Orthop Trauma 2005;19:504-7.
• Gu G, Zhang J, Wang T, Wang G. A comparison of operative and nonoperative treatment of clavicle fracture: a meta-analysis. [Article in Chinese] Journal of Practical Orthopaedics 2009;15:161-5.
• Lenza M, Belloti JC, Andriolo RB, Gomes Dos Santos JB, Faloppa F. Conservative interventions for treating middle third clavicle fractures in adolescents and adults. Cochrane Database Syst Rev 2009;2:CD007121.
• Lenza M, Belloti JC, Gomes Dos Santos JB, Matsumoto MH, Faloppa F. Surgical interventions for treating acute fractures or non-union of the middle third of the clavicle. Cochrane Database Syst Rev 2009;4:CD007428.
• Zhen X, Abuduhadeer T. Systematic review of operative and nonoperative treatment of displaced midshaft clavicular fractures. [Article in Chinese] Urumqi: Xinjiang Medical University; 2010.
• Duan X, Zhong G, Cen S, Huang F, Xiang Z. Plating versus intramedullary pin or conservative treatment for midshaft fracture of clavicle: a meta-analysis of randomized controlled trials. J Shoulder Elbow Surg 2011;20:1008-15. Oh JH, Kim SH, Lee JH, Shin SH, Gong HS. Treatment of distal clavicle fracture: a systematic review of treatment modalities in 425 fractures. Arch Orthop Trauma Surg 2011;131:525-33.
• Wang L, Ma B, Li E. Comparing the effect of operative and nonoperative treatment in adult mid-shaft clavicular fracture by meta-analysis. [Article in Chinese] Chinese Journal of Orthopaedics 2011;31:308-15.
• Ban I, Branner U, Holck K, Krasheninnikoff M, Troelsen A. Clavicle fractures may be conservatively treated with acceptable results - a systematic review. Dan Med J 2012;59:A4457.
• Houwert RM, Wijdicks FJ, Steins Bisschop C, Verleisdonk EJ, Kruyt M. Plate fixation versus intramedullary fixation for displaced mid-shaft clavicle fractures: a systematic review. Int Orthop 2012;36:579-85.
• McKee RC, Whelan DB, Schemitsch EH, McKee MD. Operative versus nonoperative care of displaced midshaft clavicular fractures: a meta-analysis of randomized clinical trials. J Bone Joint Surg Am 2012;94:675-84.
• Virtanen KJ, Malmivaara AO, Remes VM, Paavola MP. Operative and nonoperative treatment of clavicle fractures in adults. Acta Orthop 2012;83:65-73.
• Wijdicks FJ, Van der Meijden OA, Millett PJ, Verleisdonk EJ, Houwert RM. Systematic review of the complications of plate fixation of clavicle fractures. Arch Orthop Trauma Surg 2012;132:617-25.
• Xiong J, Yu B, Ouyang H, Xiang P. Operational versus nonoperational treatment for mid-shaft clavicle fractures: a meta-analysis. [Article in Chinese] Chinese Journal of Bone and Joint Injury 2012;27:199-202.
• Witzel K. Intramedullary osteosynthesis in fractures of the mid-third of the clavicle in sports traumatology. [Article in German] Z Orthop Unfall 2007;145:639-42. [Abstract]