Background:

There is no agreement on the best treatment for displaced midshaft clavicle fractures (MCFs), which are currently addressed by nonoperative or surgical approaches.

Purpose:

To compare fracture healing and functional outcome after surgical versus nonsurgical treatment of MCFs, to help specialists in deciding between these different strategies by providing a synthesis of the best literature evidence.

Study Design:

Meta-analysis.

Methods:

A systematic research of the literature was performed in different online databases: PubMed, Web of Science, Cochrane library, and grey literature. PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines were used. The risk of bias was evaluated with the Cochrane Collaboration’s “risk of bias” tool, and the quality of evidence was graded according to Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. Randomized controlled trials investigating differences between surgery and nonoperative treatment for displaced MCFs were included. The primary outcome was the nonunion rate. Other outcomes analyzed were time to union and to return to activities, Constant score, and Disabilities of the Arm, Shoulder and Hand (DASH) index. Patients’ satisfaction, secondary operations, and complications were also recorded.

Results:

Out of 832 records found, 14 randomized controlled trials with 1546 patients were included. A significantly lower risk ratio was found for nonunion (10%; 95% CI, 6%-18%, P < .001) favoring surgery. Time to union was 5.1 weeks shorter with surgery (P = .007). The complication rate (including the number of reinterventions) was higher in the surgical group (31.3% vs 20.5%, P < .001). Shoulder function at short-term follow-up was significantly better in the surgical group (DASH index mean difference = 4.0 points), while no statistical difference was found in the Constant score and in the DASH index at midterm follow-up (P = .41 and .80, respectively). At long-term follow-up, both shoulder functional scores were significantly better in the surgery group: the overall Constant score mean difference was 5.3 points (95% CI, 2.3-8.4 points; P < .001), and the DASH index mean difference was 4.3 points (95% CI, 0.2-8.4 points; P = .04).

Conclusion:

Surgical treatment of MCFs significantly reduces the nonunion rate and shortens the time to union as compared with the nonoperative approach and, despite a slightly higher incidence of complications, leads to better shoulder functional scores at short- and long-term follow-up. Further studies should address the clinical significance of the documented improvement.

中文翻译：

---

锁骨中段骨折：与非手术治疗相比，手术提供更好的结果：一项荟萃分析。

背景：

对于移位性中轴锁骨骨折（MCF）的最佳治疗方法尚无共识，目前已通过非手术或手术方法解决。

目的：

为了比较MCF的手术治疗与非手术治疗后的骨折愈合和功能预后，通过提供最佳文献证据的综合来帮助专家决定这些不同的策略。

学习规划：

荟萃分析。

方法：

在不同的在线数据库中进行了文献的系统研究：PubMed，Web of Science，Cochrane图书馆和灰色文献。使用PRISMA（系统性荟萃分析的首选报告项目）指南。使用Cochrane协作组织的“偏倚风险”工具评估了偏倚的风险，并根据“建议评估，制定和评估分级”（GRADE）指南对证据的质量进行了分级。随机对照试验研究了置换型MCF手术与非手术治疗之间的差异。主要结局是骨不连率。分析的其他结果包括工会活动和恢复活动的时间，常数得分以及手臂，肩膀和手部残疾（DASH）指数。患者的满意度，二次手术，

结果：

在发现的832条记录中，纳入了14项1546例患者的随机对照试验。发现不愈合的有利于手术的风险比率（10％； 95％CI，6％-18％，P <.001）。手术时间缩短了5.1周（P = .007）。手术组的并发症发生率（包括再次介入的次数）更高（31.3％vs 20.5％，P <.001）。在手术组中，短期随访的肩部功能明显更好（DASH指数平均差异= 4.0分），而在中期随访中，Constant评分和DASH指数均无统计学差异（P分别为0.41和.80）。在长期随访中，手术组的两个肩部功能评分均明显好于：总体恒定评分平均差异为5.3分（95％CI，2.3-8.4分；P <.001），而DASH指数均值差异为4.3点（95％CI，0.2-8.4点；P = .04）。

结论：

与非手术方法相比，MCF的外科手术治疗显着降低了骨不连率，缩短了愈合时间，尽管并发症发生率略高，但短期和长期随访时肩功能评分更高。进一步的研究应解决已证明的改善的临床意义。