Nonoperative versus surgical treatment of displaced midshaft clavicle fractures in adolescents: a systematic review and meta-analysis of comparative studies

Purpose To compare the outcomes and complications of nonoperative versus surgical treatments for displaced midshaft clavicle fractures (MCFs) in adolescents, an area where treatment recommendations remain controversial. Methods A comprehensive search of PubMed, Embase, and Cochrane databases was conducted to identify studies comparing nonoperative and surgical treatments for adolescent patients with displaced MCFs. Seven studies, including 578 adolescent patients, met the inclusion criteria. Risk ratios (RR) and mean differences (MD) were calculated using a random-effects model. Study quality was assessed using the MINORS tool. Results The risk of nonunion and malunion were higher in the nonoperative group, with RRs of 2.32 (95% CI: 0.26-20.8) and 4.46 (95% CI: 0.8-25), respectively. The surgical group had a higher refracture risk (RR: 0.46, 95% CI: 0.18-1.17). Functional outcomes (DASH scores) showed no significant differences between groups. However, nonoperative treatment was associated with significantly fewer revision surgeries (RR: 0.15, 95% CI: 0.04-0.57) and complications (RR: 0.31, 95% CI: 0.1-0.93). Conclusions Both treatment options yielded similar functional outcomes, but nonoperative management was associated with fewer revision surgeries and lower complication rates. Given the absence of significant functional advantage for surgery, nonoperative treatment may be the preferred approach for displaced MCFs in adolescents. Level of evidence Level III, Systematic review of LevelIII studies.