30.
Operative versus nonoperative treatment of displaced midshaft
clavicle fractures in adults – a systematic review.
Martin Kirkegaard, Carl-Henrik Rehn, Bjarke Viberg, Morten Schultz Larsen
Dept. of Orthopaedic Surgery and Traumatology Odense University Hospital;
Dept. of Orthopaedic Surgery and Traumatology, Odense University Hospital;
Dept. of Orthopaedic Surgery and Traumatology, Odense University Hospital;
Dept. of Orthopaedic Surgery and Traumatology, Odense University Hospital
Background:
Intervention studies regarding clavicle fractures treatment are
numerous, but few high quality studies prospectively compare operative and
nonoperative treatment.
Purpose / Aim of Study:
Evidence from randomized controlled trials (RCT)
and cohort studies on operative versus nonoperative treatment of displaced
midshaft clavicle fractures in adults were reviewed with focus on fracture
healing, complications and functional outcome.
Materials and Methods:
A search term was designed with aid of a research
librarian and the search through February 2012 on PubMed, Embase and
Cochrane Databases revealed 490 articles. These were assessed for relevance
by two reviewers independently regarding title, abstract, and full text.
Extraction of data was done by both reviewers in collaboration and sorted
regarding study aims. Complications were grouped according to additional
surgery required. The quality of studies was assessed by both reviewers in
unison using CASP 2010 checklists.
Findings / Results:
The search provided five randomized controlled trials and
a cohort study totaling 494 patients. Time to union (fracture healing) was
shorter in the operative groups. Major surgeries due to complication were 3 %
in the operative group and 14 % in the nonoperative group. Minor
complications, e.g. hardware removal, were recorded solely in the operative
group. Functional outcomes (Constant Shoulder Scores) were statistically
better for the operative groups compared with the nonoperative groups at all
time points (p<0.05). The clinical significance of these scores, however, could
not be confirmed in this systematic review.
Conclusions:
High quality evidence is currently sparse supporting either
operative or nonoperative treatment on displaced midshaft clavicle fractures in
adults.
