Systematic Review Of Operative And Nonoperative Treatment Of Displaced Midshaft Clavicular Fractures

Objective: To evaluate the effectiveness of operative and nonoperative treatment for midshaft of the clavicular displaced fracture. Methods: Randomized controlled trials(RCTs) and clinical controlled trials(CCTs) were identified from MEDLINE(1990-2009.07), EMBASE(1990-2009.09), Cochrane Library(Issue 4,2009), Cochrane Musculoskeletal Injuries Group Database(2009.07), and CBM disc(1985-2009.07). We handseaeched Chinese Journal of Orthopaedy(from 1985 to October 2009) and Orthopaedic Journal of China(from 1985 to July 2009). RCTc and CCTs were included. Data were extracted by reviewers with designed extraction fromtion from RevMan 4.2.10 software was used for data analysis. Results: 4RCTs were included. The combined results of meta-analysis showed that compared with operative treatment, nonoperative treatment can increase the rate of nonunion [RR=0.15,95%CI(0.05, 0.44), P=0.58], and the rate of symptomatic malunion [RR=0.16,95%CI(0.07, 0.40),P=0.63], and the rate of transient brachial plexus symptoms [RR=0.40, 95%CI (0.12, 1.30),P = 0.11], and mean length of time to nuion[WMD=-7.41,95%CI (-10.82, -3.99),P = 0.007], and operative treatment can increase the rate of satisfaction[RR=1.27,95%CI (1.02, 1.57),P = 0.13]. Conclusions: compared with operative treatment, nonoperative treatment can increase the rate of nonunion and the rate of symptomatic malunion and the rate of transient brachial plexus symptoms and the mean time of union, operative treatment can increase the rate of unsatisfaction. However, the relation between the two treatments and painful fracture site, deep wound infection, complex regional pain syndrome, limb shorting, constant shoulder scores, treatment of money, types of fractures and osteoporosis needs more randomized controlled trials to draw more definite conclusions.