Interventions for treating displaced midshaft @entity174 : a bayesian network meta-analysis of XXXX .

@entity1 @entity281 @entity174 @entity23
Displaced midshaft clavicle fractures are frequent injuries. There are 3 treatment methods including conservative treatment, plate fixation, and intramedullary pin fixation. However, which is the best treatment remains a topic of debate.To establish the optimum treatment for displaced midshaft @entity174 , we did a network meta-analysis to compare 3 treatments in terms of postoperative nonunion and @entity281 .We searched PubMed, the Cochrane Library, and Embase for relevant @entity23 ( @entity23 ) until the end of October 2014. Two investigators independently reviewed the abstract and full text of eligible studies and extracted information. We used WinBUGS 1.4 (Imperial College School of Medicine at St Mary's, London) to perform our Bayesian network meta-analysis. We used the graphical tools in STATA12 (StataCorp, Texas) to present the results of statistical analyses of WinBUGS14. Nonunion and @entity281 were presented as odd ratios (ORs) with 95% confidence intervals (CIs). We also presented the results using surface under the cumulative ranking curve (SUCRA). A higher SUCRA value suggests better results for respective treatment method.Thirteen @entity23 were included in our network meta-analysis, with a total of 894 @entity1 randomized to receive 1 of 3 treatments. Nonunion rates were 0.9%, 2.4%, and 11.4% for intramedullary pin fixation, plate fixation, and conservative method, respectively. Nonunion occurred more commonly in @entity1 treated with conservative method than in @entity1 treated with either plate fixation (OR, 0.18; 95% CI, 0.05-0.46) or intramedullary pin fixation (OR, 0.12; 95% CI, 0.01-0.50). There was no significant difference between plate and intramedullary pin fixation in nonunion (OR, 3.64; 95% CI, 0.31-17.27). Furthermore, SUCRA probabilities were 87.8%, 62.0%, and 0.2% for intramedullary pin fixation, plate fixation, and conservative method, respectively. Infection rates were 3.6% and 3.9% for intramedullary pin fixation and plate fixation, respectively. There was no significant difference between plate and intramedullary pin fixation in @entity281 (OR, 3.64; 95% CI, 0.31-17.27). SUCRA probabilities were 46.5% and 8.5% for intramedullary pin and plate fixation, respectively.Our network meta-analysis suggested that intramedullary pin fixation is the optimum treatment method for displaced midshaft @entity174 because of the low probabilities of nonunion and @entity281 .
