[Midshaft clavicle fractures :  A systematic review of different treatment approaches].
BACKGROUND
The objective of this systematic review was to summarize the current evidence on efficacy and safety of the various treatment options for midshaft clavicle fractures, taking into account fracture type and other variables.


METHODS
A search for systematic reviews and controlled studies  published between 1998 and 2009 was carried out.


RESULTS
There is moderate evidence that operative treatment for midshaft clavicle fractures results in a lower rate of fracture non-union and improved patient-oriented outcome compared to non-operative treatment. However, because union rates are generally high and there are complications which are unique to surgical intervention, risks have to be considered and weighed before a decision on treatment is made. The most important risk factors for non-union are major displacement and fracture comminution. Of all surgical procedures the best evidence of efficacy is presently available for plate fixation and elastic stable intramedullary nailing.


CONCLUSIONS
This paper presents an algorithm derived from the current evidence which may be useful for therapy decision-making in the clinical routine.
Felder-Puig
R
R
Ludwig Boltzmann Institut für Health Technology Assessment, Wien, Österreich. rosemarie.felder-puig@lbihpr.lbg.ac.at
Mathis
S
S
Pelinka
H
H
Mittermayr
T
T
Pieske
O
O
D000465:Algorithms; D001860:Bone Plates / Q000706:statistics & numerical data*; D002968:Clavicle / Q000293:injuries* / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000706:statistics & numerical data*; D050723:Fractures, Bone / Q000453:epidemiology* / Q000601:surgery; D006801:Humans; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D015995:Prevalence; D018570:Risk Assessment; D016896:Treatment Outcome