Factors explaining heterogeneity in studies comparing surgical and nonsurgical treatment of midshaft clavicle fractures: a meta-regression analysis of randomized controlled trials and high-quality observational studies

Journal of Shoulder and Elbow Surgery
Aleksi ReitoJuha Paloneva

Abstract

Previous meta-analyses comparing the surgical and nonsurgical treatment of midshaft clavicle fractures have demonstrated extensive heterogeneity, that is, treatment effect variation, in different pooled outcomes. We aimed to investigate the amount of heterogeneity seen in pooled treatment effects and to explore which moderator variables serve to explain this heterogeneity. A follow-up literature search, based a previous study, was conducted. All randomized controlled trials and high-quality observational studies with suitable treatment cohorts were identified and included in this systematic review and meta-regression analysis. The proportions of male patients, patients with the dominant hand injured, and smokers, as well as fracture type and mean age, were included as covariates in meta-regression analyses investigating the effect on the pooled estimate of treatment effect heterogeneity. The pooled treatment effects assessed were nonunion rate, malunion rate, Disabilities of the Arm, Shoulder and Hand score, and Constant score at 1 year, as well as revision surgery rate. High heterogeneity was observed in 4 of 8 pooled treatment effects and moderate, in 2 of 8. An association between any of the covariates, including smoking, wi...Continue Reading

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