PRE-CONTOURED PLATE VS. NON-PRE-CONTOURED PLATE

Two low quality studies were reviewed comparing pre-contoured and non-contoured plates for the treatment of clavicle fractures (Fang 2020, Rongguang 2016). Both studies demonstrated no significant differences in the rates of patient reports outcomes, or adverse events. Fang (2020) found pre-contoured plates offered a lower rate of implant deformity (0 vs. 11.3%) however implant removal rates, and clinical outcomes were similar between groups. Rongguang (2016) reported lower rates of hardware removal in the pre-contoured plate groups and those with high BMI.

Benefits/Harms of Implementation

Both pre-contoured and non-contoured plates offered similar functional outcomes across both studies. Rongguang (2016) suggested a reduced rate of implant removal which may provide the benefit of reduced incidence of revision surgery with no specific downside. Additionally, anatomically pre-contoured plates may be less likely to undergo deformity however the clinical significance of this was not demonstrated in either clinical study.

Outcome Importance

Further understanding of the utility of pre-contoured plates may provide insight into cost effective ways to manage this common pathology.

Cost Effectiveness/Resource Utilization

No evidence was presented in either study specific to cost effectiveness or resource utilization; however, given the higher rate of plate removal reported by Rongguang (2016). This is a future area of research need.

Acceptability

Both plate types (pre-contoured and non-contoured) use similar surgical techniques and would not require significant changes to established practices.

Feasibility

Anatomically pre-contoured plates are generally more expensive than non-pre-contoured plates. The availability of pre-contoured plates may be a significant deterrent to the feasibility of this recommendation in areas without access to such instrumentation.

Future Research

Further high-quality studies evaluating the clinical, radiographic, and functional outcomes of patients treated with clavicle fractures are needed. Additionally, a cost effectiveness study would help to stratify the utility of these techniques.