To date, the optimal management of displaced midshaft clavicle fractures remains unknown. Operatively, plate or nail fixation may be used. Nonoperatively, the options are sling or harness. Given the equivocal effectiveness between approaches, the costs to the health care system and the patient become critical considerations. A decision tree model was constructed to study plate and sling management of displaced midshaft clavicle fractures. Primary analysis used 6 randomized controlled trials that directly compared open reduction and internal fixation with a plate to sling. Secondary analysis included 18 studies that studied either plate, sling, or both. Incremental cost-effectiveness ratios (ICERs) were calculated using quality-adjusted life-years (QALYs). Second-order Monte Carlo probabilistic sensitivity analysis (PSA) was subsequently conducted. In primary analysis, at a willingness-to-pay (WTP) threshold of $100,000, operative management was found to be less cost-effective relative to nonoperative management, with an ICER of $606,957/QALY (0.03 additional QALYs gained for an additional $16,120). In PSA, sling management was cost-effective across all WTP ranges. In secondary analysis, the ICER decreased to $75,230/QALY. Primary analysis shows that plate management is not a cost-effective option. In secondary analysis, the incremental effectiveness of plate management increased enough that the calculated ICER is below the WTP threshold of $100,000; however, the strength of evidence in secondary analysis is lower than in primary analysis. Thus, because neither option is dominant in this model, both plate and sling remain viable approaches, although the cost-conscious decision will be to treat these fractures with a sling until future data suggest otherwise. [Orthopedics. 20XX;XX(X):xx–xx.]

迄今为止，移位锁骨中段骨折的最佳治疗方法仍然未知。在操作上，可以使用板或钉子固定。非手术时，选项是吊索或安全带。鉴于方法之间的模棱两可的有效性，医疗保健系统和患者的成本成为关键考虑因素。构建决策树模型来研究移位锁骨中段骨折的钢板和吊索管理。初步分析使用了 6 项随机对照试验，这些试验直接比较了切开复位和钢板内固定与吊索。次要分析包括 18 项研究，研究了钢板、吊索或两者。使用质量调整生命年 (QALYs) 计算增量成本效益比 (ICER)。随后进行了二阶蒙特卡罗概率敏感性分析（PSA）。在初步分析中，在 100,000 美元的支付意愿 (WTP) 阈值下，与非手术治疗相比，手术治疗的成本效益较低，ICER 为 606,957 美元/QALY（额外增加 16,120 美元可获得 0.03 QALY） . 在 PSA 中，吊索管理在所有 WTP 范围内都具有成本效益。在二次分析中，ICER 降至 75,230 美元/QALY。初步分析表明，印版管理不是一个具有成本效益的选择。在二次分析中，板块管理的增量有效性提高到足以使计算出的 ICER 低于 100,000 美元的 WTP 阈值；然而，二级分析中的证据强度低于初级分析中的证据强度。因此，因为在这个模型中这两种选择都不占主导地位，所以平板和吊索都是可行的方法，尽管考虑到成本的决定将是用吊带治疗这些骨折，直到未来的数据表明并非如此。[骨科。20XX;XX(X):xx–xx.]