Operative versus nonoperative interventions for common fractures of the clavicle: a meta-analysis of randomized controlled trials

Abstract

C lavicle fractures are common injuries, affecting about 22 000 Canadians each year and numbering 1.75 million fractures worldwide. [1][2][3][4][5][6] The majority of these fractures are located in the midshaft, accounting for about 80% of all clavicle fractures.1,2 Closed midshaft fractures were traditionally treated nonoperatively, a practice largely based on previous studies by Neer and Rowe. 7,8 In the last decade, evidence challenged the standard of nonoperative treatment, reporting high rates of nonunion (15%-20%), poor early function, and residual sequelae at 6 months following nonoperative management in up to 42% of patients.9 Small clinical trials that followed have fuelled a growing popularity to treat these fractures surgically with plates and screws or intramedullary devices; however, these procedures carry inherent surgical risks for infection, implant failure and hardware irritation requiring subsequent removal. 10,11 Whether surgery or a conservative approach is the optimal method of management for midshaft clavicle fractures is still an issue of debate. Several trials have compared operative and nonoperative approaches to treatment. In the last 5 years, a number of trials have also investigated various surgical techniques and the use of different implants. Previous reviews focused only on the operative versus nonoperative debate. 1,9,11,12 Our review adds to this body of literature by providing data from the largest and most recent trial. It also provides a summary of the evidence on surgical techniques for these injuries, as well as nonsurgical options.We performed a meta-analysis to determine the effect of operative and nonoperative interventions for treating acute displaced midshaft clavicle fractures on the risk of secondary operation and all complications and on long-term function. Background: The popularity of surgery for acute displaced midshaft clavicle fractures has been fuelled by early randomized controlled trials (RCTs) showing improved rates of radiographic union and perceived functional benefits compared with nonoperative approaches. We performed a meta-analysis to determine the effect of operative and nonoperative interventions on the risk of secondary operation and complications and on long-term function. Operative versus nonoperative interventions for common

Open reduction and plate fixation compared with non-surgical treatment for displaced midshaft clavicle fracture

“…Compared to the study by Woltz et al, [34] there was no new data on constant score, so we only analyzed the DASH score. Unlike the previous meta-analyses, [8,10,12] after updating original literature, we found no significant difference in the DASH scores at 1-year after injury between the ORPF group and the non-surgical treatment group. The understanding of PROM (Patient-reported outcome measures) (DASH score) needs to introduce the concepts of smallest detectable change (SDC) and minimal important change (MIC).…”

Avaliação clínica do tratamento cirúrgico das fraturas do terço médio da clavícula em um hospital do sul de Santa Catarina

“…1,2,10,16 The study by Asadollahi et al, 17 which is in line with the present research, reported a prevalence of male patients when compared to females, and a mean age of 39.1 years. Napora et al 3 and Devji et al 18 reported a mean age between 26.5 and 44.2 years, as well as a higher predominance of men, ranging from 53 to 91% of the study cases.…”

Closed midshaft clavicle fractures

“…Beyond these indications, there is controversy over which specific fracture patterns to treat and when. [5][6][7][8] In the UK, clavicle fractures may not be treated by a specialist trauma or upper limb surgeon in the setting of a general fracture clinic. The current literature can be difficult to interpret, leading to potential variation in treatment.…”

“…Beyond these indications, there is controversy over which specific fracture patterns to treat and when. 5 - 8…”