The clavicle is the frame bone that connects the upper limbs and the trunk, and clavicle fractures account for about 2.6% of all fractures in the whole body. Distal clavicle fractures occur in the lateral 1/3 of the clavicle, accounting for about 21%-28% of all clavicle fractures. The modified Neer classification divides distal clavicle fractures into types I to V according to the relationship between the fracture line, the coracoclavicular ligament (CC), and the acromioclavicular joint. Neer I, III, and IV fractures can achieve an excellent curative effect through non-surgical treatment of the affected limb suspension brace; Neer II and V types are unstable fractures with large displacement, and non-operative treatment of nonunion High incidence, often choose surgery. Relevant studies have shown that 68% of the fixation methods use anatomical locking plates, which may be related to its advantages of fitting the shape of the distal clavicle, stably fixing minor fractures, and allowing early movement of the affected arm. Complications such as shoulder joint pain are more common, and the current use is gradually decreasing. Unstable distal clavicle fractures are often accompanied by a coracoclavicular ligament injury, which causes stress concentration in the distal clavicle. Whether an anatomical locking plate should be combined with CC reconstruction to relieve distal stress is still controversial. Some scholars believe that when the locking plate remains stable, the CC will heal in a tension-free state, and the strength is close to that of normal ligaments. No other CC reconstruction is required, and an excellent curative effect can be obtained by simple anatomical locking plate fixation. Other scholars believe that the injury of the coracoclavicular ligament leads to severe displacement of the fracture end and increases the chance of nonunion after surgery. Therefore, anatomical locking plate fixation combined with CC reconstruction is advocated for treatment. Objective Meta-analysis was used to compare the efficacy of anatomical locking plate internal fixation combined with and without CC reconstruction in treating unstable distal clavicle fractures.

We used computers to search PubMed, Embase, Cochrane Library, CNKI, WanFang Data, and VIP databases, supplemented by manual search, and collected all comparisons of anatomical locking plate internal fixation with and without CC reconstruction from the self-built database to June 2022. Randomized controlled or case-control studies of stable distal clavicle fractures. The quality of the literature included in the included studies was strictly evaluated, and relevant data were extracted (incision length, operation time, intraoperative blood loss, hospital stay, fracture healing time, postoperative complications, coracoclavicular distance at last follow-up, Constant-Murley shoulder joint at last follow-up) Functional score), and Meta-analysis was performed using RevMan5.4 software.

A total of 8 retrospective cohort studies with 279 patients were included. One hundred thirty-eight cases underwent anatomical locking plate internal fixation combined with CC reconstruction in the reconstruction group, and 141 cases underwent simple anatomical locking plate internal fixation in the non-reconstruction group. Meta-analysis results showed that the operation time in the non-reconstruction group was shorter than that in the reconstruction group [MD=8.88, 95% CI (3.76, 13.99), P<0.05], and the coracoclavicular distance at the last follow-up was greater than that in the reconstruction group [MD=-0.43, 95% CI (-0.66, -0.20), P<0.05], the Constant-Murley shoulder joint function score at the last follow-up was lower than that in the reconstruction group [MD=4.67, 95% CI (1.52, 7.82), P<0.05], and the fracture healing time was longer than that in the reconstruction group [MD=-0.98, 95% CI (-1.94, -0.02), P=0.04]. In the non-reconstruction group and the reconstruction group, the incision length [MD=0.34, 95% CI (-0.17, 0.86), P=0.19], hospital stay [MD=-0.69, 95% CI (-1.51, 0.12), P=0.10], intraoperative blood loss [MD=11.66, 95% CI (-2.31, 25.63), P=0.10] and postoperative complications [OR=1.07, 95% CI (0.42, 2.71), P=0.89] The differences were not statistically significant.

Compared with internal fixation with anatomical locking plate alone, anatomical locking plate combined with CC reconstruction in the treatment of unstable distal clavicle fractures has a smaller coracoclavicular distance, higher Constant-Murley shoulder joint function score, and shorter fracture healing time at the last follow-up and effective treatment option. This conclusion needs to be verified by further prospective, large-sample randomized controlled studies.