title: Operative versus nonoperative treatment for displaced midshaft clavicular fractures: a meta-analysis of randomized clinical trials.
abstract: BACKGROUND
  There is insufficient evidence to indicate whether operative or nonoperative treatment is better for treating displaced midshaft clavicular fractures. We undertook a systematic review and meta-analysis of randomized controlled trials (RCTs) to compare the effects of the two treatments.
  
  
  METHODS
  We searched the PubMed, EMBASE and Cochrane Library databases, and identified RCTs to compare the Constant score, DASH score, nonunion, malunion, and adverse events between operative and nonoperative groups of patients with displaced midshaft clavicular fractures.
  
  
  RESULTS
  A total of 507 patients from 6 RCTs were subjected to meta-analysis. Operative treatment has an effect on improving function, which is demonstrated by significantly higher Constant scores (P = 0.0003) and lower DASH scores (P = 0.03). The rate of nonunion and the rate of malunion were significantly lower in operative group compared with that in nonoperative group (both P < 0.0001). However, the rate of adverse events was significantly higher in operative group compared with that in nonoperative group (P = 0.003).
  
  
  CONCLUSIONS
  Operative treatment provided a significantly better functional outcome, a lower rate of nonunion and malunion, but was accompanied with a higher rate of adverse events. However, the results should be interpreted with caution and further large-scale, well-designed RCTs on this topic are still needed.
authors.affiliation: Department of Orthopedics, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.
authors.forename: Lingde
authors.initials: L
authors.lastname: Kong
authors.forename: Yingze
authors.initials: Y
authors.lastname: Zhang
authors.forename: Yong
authors.initials: Y
authors.lastname: Shen
mesh_terms: D002968:Clavicle / Q000293:injuries*; D004185:Disability Evaluation; D005592:Fracture Fixation / Q000379:methods*; D050723:Fractures, Bone / Q000601:surgery / Q000628:therapy*; D006801:Humans; D011183:Postoperative Complications; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D016896:Treatment Outcome