Treatment of Displaced Midshaft Clavicle Fractures: Figure-of-Eight Harness Versus Anterior Plate Osteosynthesis

Abstract

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Surgical or non-surgical treatment of traumatic skeletal fractures in adults: systematic review and meta-analysis of benefits and harms

“…For 6 out of the 8 fracture types with available data on SAEs from at least two trials, no differences were demonstrated between surgical and non-surgical treatment. For displaced midshaft clavicula fractures (14 trial (n = 1394)) [24][25][26][27][28][29][30][31][32][33][34][35][36][37], surgery was associated with a smaller risk of SAEs than non-surgical treatment (RR 0.62 (0.42 to 0.92)). For distal radius fracture (5 trials (n = 436)) [59-61, 65, 80], surgery was associated with a greater risk of SAEs than non-surgical treatment (RR 3.10, 95% CI 1.42 to 6.77).…”

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

“…Besides 1 study [26] whose full text cannot be obtained, 3 articles including 1 QRCT, [27] 1 cohort study, [28] and 1 duplicate study (Summary and Review) [29] were excluded after reading the full texts. Finally, 9 RCTs [14–16,22,30–34] were included in the present meta-analysis. The details of the literature retrieval were shown in the flowchart (Fig.…”

“…Using random-effects model, there was no significant difference between the 2 groups (RR, 0.53[95%CI 0.23–1.25], P = .15). Sensitivity analysis found that heterogeneity was significantly lower after removing the study by Tamaoki et al, [16] and appearance dissatisfaction rate was relatively lower in the ORPF group (RR, 0.35 [95% CI 0.23–0.55], P < .001). Based on above results, we cautiously drew the conclusion that appearance dissatisfaction rate in the ORPF group was not higher than that in the non-surgical treatment group.…”

“…Four studies [16,22,31,32] clearly reported data on shoulder appearance (Table 2). Figure 8 showed the results of meta-analysis.…”

“…We included only randomized clinical trials (RCT) studies and updated original studies. [14–16] Given the potential for clinical heterogeneity between different surgical procedures such as intramedullary fixation and open reduction and plate fixation (ORPF), we selected only the more widely used ORPF and compared it with non-surgical treatment. We also found that the problem of confusing intent-to-treat (ITT) analysis and per-protocol (PP) analysis existing in most published studies.…”