Operative versus nonoperative interventions for common fractures of the clavicle: a meta-analysis of randomized controlled trials

CMAJ Open
Tahira DevjiMohit Bhandari

Abstract

The popularity of surgery for acute displaced midshaft clavicle fractures has been fuelled by early randomized controlled trials (RCTs) showing improved rates of radiographic union and perceived functional benefits compared with nonoperative approaches. We performed a meta-analysis to determine the effect of operative and nonoperative interventions on the risk of secondary operation and complications and on long-term function. We search MEDLINE, Embase and the Cochrane Central Register of Controlled Trials for reports of relevant RCTs published to Mar. 7, 2014. Two reviewers assessed eligibility of potential reports and the risk of bias of included trials. The Grading of Recommendations Assessment, Development and Evaluation approach was used to summarize the quality of evidence for all outcomes. We included 15 RCTs (9 trials comparing operative and nonoperative interventions, 5 comparing implants for operative treatment, and 1 comparing nonoperative treatments). Nonoperative treatments did not differ from operative treatments in the risk of secondary operation (risk ratio [RR] 1.16, 95% confidence interval [CI] 0.58 to 2.35) or all complications (RR 0.90, 95% CI 0.55 to 1.50). One in 4 patients had a complication regardless of...Continue Reading

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Citations

Jan 19, 2017·The Journal of Bone and Joint Surgery. American Volume·Sarah WoltzInger B Schipper
Jun 21, 2017·The Journal of Bone and Joint Surgery. American Volume·Sarah WoltzInger B Schipper
Sep 5, 2018·The Journal of the American Academy of Orthopaedic Surgeons·Brent WieselRyan Churchill
Jan 23, 2019·The Cochrane Database of Systematic Reviews·Mário LenzaFlávio Faloppa

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