Operative versus nonoperative treatment of displaced midshaft clavicle fractures in adults: a systematic review

Abstract

Intervention studies of clavicle fracture treatment are numerous, but only a few high quality studies prospectively compare operative and nonoperative treatment. The objective of this study was to review evidence from randomized controlled trials on operative versus nonoperative treatment of displaced midshaft clavicle fractures in adults with focus on fracture healing, complications and functional outcome. An electronic search was performed of PubMed, Embase and Cochrane databases which revealed 559 articles. All articles published before October 18th 2012 and written in English, Danish or Swedish were eligible. Articles were excluded if they included children under the age of 16, did not include acute midshaft fractures, included concomitant fractures, did not meet the requirements of Level I evidence according to Centre for evidence based medicine 2009 guidelines, were systematic reviews or meta-analyses, or did not compare operative and nonoperative treatment. Articles were parsed for relevance by two reviewers independently regarding title, abstract, and full text. Extraction of data was done by both reviewers in collaboration and sorted according to the aims of the study. Complications were grouped according to additional surgery required. The quality of studies was assessed by both reviewers in unison using Critical Appraisal Skills Programme 2010 checklists. It seems like operative intervention leads to fewer nonunions at the cost of an increase in minor complications compared to nonoperative treatment. However, the effects of operation on functional outcome remains controversial. High quality evidence is currently sparse supporting either operative or nonoperative treatment on displaced midshaft clavicle fractures in adults.