Nonoperative vs Operative Treatment of Displaced Mid-Shaft Clavicular Fractures: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Introduction: Among the general population, clavicle fractures are quite prevalent. Displaced midshaft clavicle fractures are still debatable in terms of the best way to treat them. The efficacy and safety of nonoperative therapy vs open reduction and internal fixation (ORIF) for displaced midshaft clavicle fractures in adults was evaluated by a comprehensive review and meta-analysis of randomized controlled trials (RCTs). Materials and methods: RCTs evaluating outcomes of interest among conservative therapy and ORIF of mid shaft clavicular fractures were sought by searches of major databases for example PubMed, Embase, Web of Science, and Scopus. We extracted data on functional outcomes; including Constant Murley score (CMS) and Disability Assessment of Shoulder and Hand (DASH), time to go back to work, and complication rate, involving nonunion, malunion, and secondary surgery. Results: We found 9 RCTs that fulfilled our inclusion criteria, with a total of 1259 cases, 626 cases experienced nonoperative treatment and 633 cases underwent clavicular plating. Based on our research, we found that nonoperative treatment was related to greater nonunion rates contrasted with ORIF. However, both techniques had similar functional outcomes, time to return to work, and rates of secondary surgery. Conclusion: Although conservative treatment and plating demonstrated different effects on nonunion rates of mid shaft clavicular fractures, no treatment modality was found to be superior in light of functional outcomes, time to get back to work, and secondary surgery. More homogenous, high-quality RCTs with longer follow-up durations and larger sample sizes are recommended.