title: Operative versus nonoperative treatment in the management of midshaft clavicular fractures: a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  There is no consensus on the effects of operative versus nonoperative treatment on the outcomes of midshaft clavicular fractures in adults. We conducted a meta-analysis of randomized clinical studies.
  
  
  METHODS
  We searched the literature and included studies that investigated the effects of operative versus nonoperative intervention on the outcome of midshaft clavicular fractures. Patient data were pooled by use of standard meta-analytic approaches. For the continuous variables, the weighted mean difference was used. For dichotomous data, the relative risk was calculated.
  
  
  RESULTS
  Seven studies reported in 8 publications were eligible for data extraction. The pooled analyses showed that, compared with nonoperative treatment, operative treatment led to significantly lower incidences of nonunion and fewer symptomatic malunions. Subgroup analysis indicated that these advantages could be ascribed to plate fixation. Furthermore, surgery with plates resulted in significantly fewer complications. Patients undergoing surgery had better Disabilities of the Arm, Shoulder and Hand and Constant scores and lower dissatisfaction with their appearance.
  
  
  CONCLUSIONS
  In the management of midshaft clavicular fractures, surgery is superior to nonoperative treatment. Surgery with plates results in lower incidences of nonunion, fewer total complications, and fewer symptomatic malunions compared with nonoperative treatment.
authors.affiliation: Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Xu
authors.affiliation: Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Xu
authors.affiliation: Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.
authors.forename: Wendong
authors.initials: W
authors.lastname: Xu
authors.affiliation: Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.
authors.forename: Yudong
authors.initials: Y
authors.lastname: Gu
authors.affiliation: Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China. Electronic address: x.jianguang@yahoo.com.
authors.forename: Jianguang
authors.initials: J
authors.lastname: Xu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001860:Bone Plates; D002968:Clavicle / Q000293:injuries*; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation; D050723:Fractures, Bone / Q000601:surgery* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D016896:Treatment Outcome; D055815:Young Adult
keywords: Level II; Meta-Analysis; Midshaft clavicular; intramedullary fixation; meta-analysis; nonoperative treatment; plating