Skip to main content
SpringerLink
Log in

Operative versus nonoperative treatment for displaced midshaft clavicular fractures: a meta-analysis of randomized clinical trials

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

There is insufficient evidence to indicate whether operative or nonoperative treatment is better for treating displaced midshaft clavicular fractures. We undertook a systematic review and meta-analysis of randomized controlled trials (RCTs) to compare the effects of the two treatments.

Methods

We searched the PubMed, EMBASE and Cochrane Library databases, and identified RCTs to compare the Constant score, DASH score, nonunion, malunion, and adverse events between operative and nonoperative groups of patients with displaced midshaft clavicular fractures.

Results

A total of 507 patients from 6 RCTs were subjected to meta-analysis. Operative treatment has an effect on improving function, which is demonstrated by significantly higher Constant scores (P = 0.0003) and lower DASH scores (P = 0.03). The rate of nonunion and the rate of malunion were significantly lower in operative group compared with that in nonoperative group (both P < 0.0001). However, the rate of adverse events was significantly higher in operative group compared with that in nonoperative group (P = 0.003).

Conclusions

Operative treatment provided a significantly better functional outcome, a lower rate of nonunion and malunion, but was accompanied with a higher rate of adverse events. However, the results should be interpreted with caution and further large-scale, well-designed RCTs on this topic are still needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Pecci M, Kreher JB (2008) Clavicle fractures. Am Fam Physician 77(1):65–70

    PubMed  Google Scholar 

  2. Postacchini F, Gumina S, De Santis P et al (2002) Epidemiology of clavicle fractures. J Shoulder Elbow Surg 11(5):452–456

    Article  PubMed  Google Scholar 

  3. Grassi FA, Tajana MS, D’Angelo F (2001) Management of midclavicular fractures: comparison between nonoperative treatment and open intramedullary fixation in 80 patients. J Trauma 50(6):1096–1100

    Article  PubMed  CAS  Google Scholar 

  4. Nordqvist A, Petersson CJ, Redlund-Johnell I (1998) Mid-clavicle fractures in adults: end result study after conservative treatment. J Orthop Trauma 12(8):572–576

    Article  PubMed  CAS  Google Scholar 

  5. Hill JM, McGuire MH, Crosby LA (1997) Closed treatment of displaced middle-third fractures of the clavicle gives poor results. J Bone Joint Surg Br 79(4):537–539

    Article  PubMed  CAS  Google Scholar 

  6. McKee MD, Pedersen EM, Jones C et al (2006) Deficits following nonoperative treatment of displaced midshaft clavicular fractures. J Bone Joint Surg Am 88(1):35–40. doi:10.2106/JBJS.D.02795

    Article  PubMed  Google Scholar 

  7. Nowak J, Holgersson M, Larsson S (2005) Sequelae from clavicular fractures are common: a prospective study of 222 patients. Acta Orthop 76(4):496–502. doi:10.1080/17453670510041475

    Article  PubMed  Google Scholar 

  8. Liu PC, Chien SH, Chen JC et al (2010) Minimally invasive fixation of displaced midclavicular fractures with titanium elastic nails. J Orthop Trauma 24(4):217–223. doi:10.1097/BOT.0b013e3181b8ba33

    Article  PubMed  CAS  Google Scholar 

  9. Mueller M, Burger C, Florczyk A et al (2007) Elastic stable intramedullary nailing of midclavicular fractures in adults: 32 patients followed for 1–5 years. Acta Orthop 78(3):421–423. doi:10.1080/17453670710014013

    Article  PubMed  Google Scholar 

  10. McKee RC, Whelan DB, Schemitsch EH et al (2012) Operative versus nonoperative care of displaced midshaft clavicular fractures: a meta-analysis of randomized clinical trials. J Bone Joint Surg Am 94(8):675–684. doi:10.2106/jbjs.j.01364

    Article  PubMed  Google Scholar 

  11. Yadav V, Khare GN, Singh S et al (2013) A prospective study comparing conservative with operative treatment in patients with a ‘floating shoulder’ including assessment of the prognostic value of the glenopolar angle. Bone Joint J 95-B(6):815–819. doi:10.1302/0301-620x.95b6.31060

    Article  PubMed  CAS  Google Scholar 

  12. Schemitsch LA, Schemitsch EH, Veillette C et al (2011) Function plateaus by one year in patients with surgically treated displaced midshaft clavicle fractures. Clin Orthop Relat Res 469(12):3351–3355. doi:10.1007/s11999-011-1915-x

    Article  PubMed  PubMed Central  Google Scholar 

  13. Neuhaus V, Ring D (2013) Effect of different statistical methods on union or time to union in a published study about clavicular fractures. J Shoulder Elbow Surg 22(4):471–477. doi:10.1016/j.jse.2012.03.015

    Article  PubMed  Google Scholar 

  14. Pearson AM, Tosteson AN, Koval KJ et al (2010) Is surgery for displaced, midshaft clavicle fractures in adults cost-effective? Results based on a multicenter randomized, controlled trial. J Orthop Trauma 24(7):426–433. doi:10.1097/BOT.0b013e3181c3e505

    Article  PubMed  Google Scholar 

  15. Stegeman SA, de Jong M, Sier CF et al (2011) Displaced midshaft fractures of the clavicle: non-operative treatment versus plate fixation (Sleutel-TRIAL). A multicentre randomised controlled trial. BMC Musculoskelet Disord 12:196. doi:10.1186/1471-2474-12-196

    Article  PubMed  PubMed Central  Google Scholar 

  16. Society COT (2007) Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am 89(1):1–10. doi:10.2106/JBJS.F.00020

    Article  Google Scholar 

  17. Judd DB, Pallis MP, Smith E et al (2009) Acute operative stabilization versus nonoperative management of clavicle fractures. Am J Orthop (Belle Mead NJ) 38(7):341–345

    Google Scholar 

  18. Smekal V, Irenberger A, Struve P et al (2009) Elastic stable intramedullary nailing versus nonoperative treatment of displaced midshaft clavicular fractures-a randomized, controlled, clinical trial. J Orthop Trauma 23(2):106–112. doi:10.1097/BOT.0b013e318190cf88

    Article  PubMed  Google Scholar 

  19. Mirzatolooei F (2011) Comparison between operative and nonoperative treatment methods in the management of comminuted fractures of the clavicle. Acta Orthop Traumatol Turc 45(1):34–40. doi:10.3944/aott.2011.2431

    Article  PubMed  Google Scholar 

  20. Virtanen KJ, Remes V, Pajarinen J et al (2012) Sling compared with plate osteosynthesis for treatment of displaced midshaft clavicular fractures: a randomized clinical trial. J Bone Joint Surg Am 94(17):1546–1553. doi:10.2106/JBJS.J.01999

    Article  PubMed  Google Scholar 

  21. Robinson CM, Goudie EB, Murray IR et al (2013) Open reduction and plate fixation versus nonoperative treatment for displaced midshaft clavicular fractures: a multicenter, randomized, controlled trial. J Bone Joint Surg Am 95(17):1576–1584. doi:10.2106/JBJS.L.00307

    Article  PubMed  CAS  Google Scholar 

  22. Zlowodzki M, Zelle BA, Cole PA et al (2005) Treatment of acute midshaft clavicle fractures: systematic review of 2144 fractures: on behalf of the Evidence-Based Orthopaedic Trauma Working Group. J Orthop Trauma 19(7):504–507

    Article  PubMed  Google Scholar 

  23. Smekal V, Oberladstaetter J, Struve P et al (2009) Shaft fractures of the clavicle: current concepts. Arch Orthop Trauma Surg 129(6):807–815. doi:10.1007/s00402-008-0775-7

    Article  PubMed  Google Scholar 

  24. Golish SR, Oliviero JA, Francke EI et al (2008) A biomechanical study of plate versus intramedullary devices for midshaft clavicle fixation. J Orthop Surg Res 3:28. doi:10.1186/1749-799X-3-28

    Article  PubMed  PubMed Central  Google Scholar 

  25. Higgins JPT (2011) In: Green S (eds) Cochrane handbook for systematic reviews of interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration. http://www.cochrane-handbook.org

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Orthopedics, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People’s Republic of China

    Lingde Kong, Yingze Zhang & Yong Shen

Authors
  1. Lingde Kong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yingze Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yong Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yong Shen.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kong, L., Zhang, Y. & Shen, Y. Operative versus nonoperative treatment for displaced midshaft clavicular fractures: a meta-analysis of randomized clinical trials. Arch Orthop Trauma Surg 134, 1493–1500 (2014). https://doi.org/10.1007/s00402-014-2077-6

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-014-2077-6

Keywords

Search

Navigation