title: Should displaced midshaft clavicular fractures be treated surgically? A meta-analysis based on current evidence.
abstract: OBJECTIVE
  This study was designed to compare clinical effectiveness of operative with nonoperative treatment for displaced midshaft clavicular fractures (DMCF).
  
  
  METHODS
  We systematically searched electronic databases (MEDILINE, EMBASE, CLINICAL, OVID, BIOSIS and Cochrane registry of controlled clinical trials) to identify randomized controlled trials (RCTs) in which operative treatment was compared with nonoperative treatment for DMCF from 1980 to 2012. The methodologic quality of trials was assessed. Data from chosen studies were pooled with using of fixed-effects and random-effects models with mean differences and risk ratios for continuous and dichotomous variables, respectively.
  
  
  RESULTS
  Four RCTs with a total of 321 patients were screened for the present study. Results showed that the operative treatment was superior to the nonoperative treatment regarding the rate of nonunion [95 % confidence interval (CI) (0.05, 0.43), P = 0.0004], malunion [95 % CI (0.06, 0.34), P < 0.00001] and overall complication [95 % CI (0.43-0.76), P = 0.0001]. Subgroup analyses of complications revealed that significant differences were existed in the incidence of neurologic symptoms [95 % CI (0.20, 0.74), P = 0.004] and dissatisfaction with appearance [95 % CI (0.19, 0.65), P = 0.001]. Lack of consistent and standardized assessment data, insufficiency analysis that carried out showed improved functional outcomes (P < 0.05) in operative treatment.
  
  
  CONCLUSIONS
  The available evidence suggests that the operative treatment for DMCF is associated with a lower rate of nonunion, malunion and complication than nonoperative treatment. This study supports traditional primary operative treatment for DMCF in active adults.
authors: Orthopaedics and Trauma, NanFang Hospital, Southern Medical University, No. 1838 Guangzhou Da Dao Bei, Guangzhou, Guangdong Province 510515, China.
authors: Chang-peng
authors: CP
authors: Xu
authors: Xue
authors: X
authors: Li
authors: Zhuang
authors: Z
authors: Cui
authors: Xi-cai
authors: XC
authors: Diao
authors: Bin
authors: B
authors: Yu
mesh_terms: D002968:Clavicle / Q000293:injuries*; D016208:Databases, Factual; D005593:Fracture Fixation, Internal / Q000379:methods*; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D011183:Postoperative Complications; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D016896:Treatment Outcome