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Review
. 2015 Aug;70(8):584-92.
doi: 10.6061/clinics/2015(08)09.

Operative versus nonoperative treatment for displaced midshaft clavicle fractures: a meta-analysis based on current evidence

Xin-Hua Wang  1 , Wei-Jun Guo  1 , A-Bing Li  1 , Guang-Jun Cheng  1 , Tao Lei  1 , You-Ming Zhao  1
Affiliations
Review

Operative versus nonoperative treatment for displaced midshaft clavicle fractures: a meta-analysis based on current evidence

Xin-Hua Wang et al. Clinics (Sao Paulo). 2015 Aug.

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.

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Figures

Figure 1
Figure 1
Flow chart showing article selection.
Figure 2
Figure 2
Forest plot showing comparison of nonunion rate (A) and symptomatic malunion rate (B) between operative (experimental) and nonoperative (control) groups.
Figure 3
Figure 3
Forest plot showing comparison of Constant scores (A) and DASH scores (B) between operative (experimental) and nonoperative (control) groups.
Figure 4
Figure 4
Forest plot showing comparison of complications rates (A and B) and neurologic symptoms rates (C) between operative (experimental) and nonoperative (control) groups.
Figure 5
Figure 5
Funnel plot of detection of publication bias.
See this image and copyright information in PMC

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