Open reduction and plate fixation compared with non-surgical treatment for displaced midshaft clavicle fracture A meta-analysis of randomized clinical trials

Backgrounds: There is no consensus concerning whether surgery or non-surgical treatment is preferred for displaced midshaft clavicle fracture. We performed a meta-analysis of randomized controlled trials (RCTs) to compare healing effects and cosmetic results between surgery and non-surgery. Methods: We retrieved RCTs regarding open reduction and plate fixation (ORPF) and non-surgical method for the treatment of displaced midshaft clavicle fracture published before June 2018 from PubMed, EMBASE and Cochrane Library. The difference between the two treatments was comparatively discussed in aspects of nonunion, malunion, functional outcome, cosmetic results, and complications. Results: Nine RCTs were included. The results showed that ORPF is advantageous over the non-surgical treatment in terms of nonunion rate (RR, 0.11[95% CI, 0.06-0.23]), malunion rate (RR, 0.16[95% CI, 0.08-0.35]), appearance dissatisfaction rate (RR, 0.35[95% CI 0.23-0.55]), and shoulder appearance defect rate (RR, 0.06[95% CI, 0.02-0.17]). The non-surgical treatment showed lower rate of complication (RR, 1.60[95% CI, 1.02-2.53]) and no significant differences were found between the 2 treatment groups with respect to functional outcome (disabilities of the arm, shoulder and hand (DASH) questionnaire score) (MD, -4.17[95% CI, -9.35 to 1.01]). Conclusions: This meta-analysis updated previous results. The current findings suggested that ORPF yielded better efficacy than conservation treatment for displaced midshaft clavicle fracture from perspectives of fracture healing and appearance.