Journal
MEDICINE
Volume 98, Issue 20, Pages -Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MD.0000000000015638
Keywords
meta-analysis; midshaft clavicle fracture; non-surgical treatment; open reduction and plate fixation
Categories
Funding
- National Natural Science Foundation of China (NSFC) [11671168]
- Science and Technology Developing Plan of Jilin Province [20170101061JC]
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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.
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