Abstract
Literature searches of the Cochrane Library, PubMed, EMBASE, Web of Science, LILACS, China National Knowledge Infrastructure, and Wanfang Data databases were performed from 1966 to September 2014. Only randomized and quasi-randomized controlled clinical trials comparing operative and nonoperative treatments for displaced midshaft clavicle fractures were included. Data collection and extraction, quality assessment, and data analyses were performed according to the Cochrane standards. Thirteen studies were considered in the meta-analysis. Constant scores and the Disabilities of the Arm, Shoulder and Hand scores were improved in the operative fixation group at a follow up of one year or more. The nonunion and symptomatic malunion rates were significantly lower in the operative group. Additionally, the nonoperative group had a higher likelihood of neurological symptoms compared with the operative group. A significantly higher risk of complications was found in patients treated conservatively than in those who underwent operative fixation. However, when patients with nonunion and symptomatic malunion were excluded from the analysis, no significant differences in the complication rate were found. We concluded that based on the current clinical reports, operative treatment is superior to nonoperative treatment in the management of displaced midshaft clavicle fractures. However, we do not support the routine use of primary operative fixation for all displaced midshaft clavicle fractures in adults.
Highlights
Clavicle fractures, which account for approximately 2.6% of total body fractures and 34-45% of shoulder girdle injuries in adults, are among the most common bone injuries in the body [1,2]
Our meta-analysis revealed that primary operative fixation could effectively reduce the rates of nonunion, symptomatic malunion, neurological symptoms and overall complications
DASH and Constant scores were significantly improved after operative fixation compared with nonoperative treatment after a follow up of one year or more
Summary
Clavicle fractures, which account for approximately 2.6% of total body fractures and 34-45% of shoulder girdle injuries in adults, are among the most common bone injuries in the body [1,2]. Most acute displaced midshaft clavicles fractures are treated nonoperatively with the expectationsof a high probability of fracture union, good functional outcomes and a high level of patient satisfaction [4,5,6,7,8]. The outcomes of nonoperative treatment are not as favorable as once thought, and the trend to surgically treat these fractures has grown [9,10]. Whether surgical treatment is associated with improved outcomes remains unknown.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
