Plate Fixation Versus Intramedullary Nailing for Displaced Clavicular Shaft Fractures: An Updated Meta-Analysis of Randomized Controlled Trials

Clavicle fractures are a common injury encountered in orthopedic practice, particularly among young, active individuals and older adults with multiple comorbidities. Severely displaced fractures are often treated surgically, with plate fixation (PF) and intramedullary nailing (IMN) representing the two most widely accepted approaches. While both techniques are commonly used, it remains relatively unclear which method yields superior post-operative outcomes. This meta-analysis aims to compare PF and IMN in the surgical management of clavicle fractures by investigating functional recovery scores and perioperative outcomes. A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted. Studies included in this meta-analysis comprised patients with clavicle fractures treated with either PF or IMN who reported at least one of the following outcomes: Constant-Murley score; Disabilities of the Arm, Shoulder, and Hand (DASH) score; union time; incision length; or operative time. Seven RCTs, involving a total of 455 patients, met the inclusion criteria. The National Institute of Health Quality Assessment Tool was used for risk of bias assessment, and random-effects models were used for data analysis. No significant differences were found between PF and IMN in terms of the Constant-Murley score, DASH score, union time, and operative time, with an overall effect size of -2.67, 4.32, 0.66, and 2.80, respectively. However, IMN was associated with a significantly shorter incision length, with an overall effect size of 6.70, highlighting its minimally invasive nature. Heterogeneity was moderate to high for all outcome measures (I² range: 61.0%-96.2%), indicating appreciable variability between studies. While both techniques are proven to be effective, the choice of surgical method should be tailored to individual patient needs, surgeon experience, and specific fracture characteristics. As variability in outcomes and practice patterns persists, additional high-quality RCTs are needed to clarify long-term differences in functional recovery and surgical outcomes in the operative management of clavicle fractures.