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Hook Plate Fixation for Acute Unstable Distal Clavicle Fracture

A Systematic Review and Meta-analysis

Asadollahi, Saeed MD, FRACS*; Bucknill, Andrew MBBS, Msc, FRCS, FRACS*,†

doi: 10.1097/BOT.0000000000001481
Review Article

Objectives: To compare the outcome of hook plate fixation with other techniques in surgical fixation of acute unstable distal clavicle fractures.

Data Sources: In July 2018, a systematic search of electronic databases (PubMed, Medline, Embase, and Cochrane databases for systematic reviews) was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Articles were limited to English language.

Study Selection: Studies were included if they compared the results of hook plate fixation of acute unstable distal clavicle fracture in adults with other surgical techniques.

Data Extraction: Data on the study setting, functional outcome, union, and complication rates were extracted. A quality assessment was performed using the Newcastle–Ottawa Scale.

Data Synthesis: Eleven studies were found that met the inclusion criteria. Six hundred thirty-four patients were pooled using a random effects model. There were 397 male and 237 female patients. Primary outcome measure was functional result, and the secondary outcome measures were union and complication rates. There was no significant difference between the functional outcome and union rate between hook plate fixation, coracoclavicular (CC) stabilization, and locking plate fixation. Hook plate fixation resulted in a higher Constant–Murley score compared with tension band wiring (TBW) [odds ratio (OR), 3.52; 95% confidence interval (CI), 0.79–6.26]. It was also associated with a higher complication rate compared with CC stabilization (OR, 3.68; 95% CI, 1.19–11.33) and the locking plate (OR, 5.19; 95% CI, 1.58–17.06). Compared with TBW, hook plate fixation was associated with a lower complication rate (OR, 0.28; 95% CI, 0.10–0.77).

Conclusions: Hook plate fixation achieves a similar functional outcome and union rate compared with CC stabilization and locking plate fixation. However, it has a superior functional result compared with TBW. The complication rate is higher compared with CC stabilization and locking plate fixation and is lower compared with TBW.

Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

*Department of Orthopaedic Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia; and

Department of Surgery (RMH), The University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia.

Reprints: Saeed Asadollahi, MD, FRACS, Department of Orthopaedic Surgery, The Royal Melbourne Hospital, Parkville, Victoria 3050, Australia (e-mail:

The authors report no conflict of interest.

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Accepted March 01, 2019

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