Clavicle fractures may be conservatively treated with acceptable results - a systematic review

INTRODUCTION: The optimal treatment of acute, displaced midshaft clavicle fractures is controversial. Despite lack of compelling evidence towards superior results after primary surgery, it seems that more and more patients are treated surgically. The aim of this study was to investigate which treatment modality should be preferred in this population according to current literature. METHOD: Randomized trials and prospective cohort studies comparing different treatment modalities for acute, displaced midshaft clavicle fracture in adults, published in English from 1966 to August 2011 were sought via an electronic database search ( MEDLINE). RESULTS: Five studies with a total of 365 patients were identified. All fractures were described as midshaft fractures with complete displacement of their bony parts. Overall, the functional outcome ( measured with the Constant score) was better in the surgically treated groups than in the conservatively treated groups. Likewise, union rates were higher in the surgical groups than in the conservative groups. Overall, complication rates were close to 30% in the surgically treated groups compared with 47% in the conservatively treated groups. CONCLUSION: Surgical treatment of acute, displaced midshaft clavicle fractures with a plate yields a better functional outcome and lower mal- and nonunion rates than conservative treatment. However, the clinical relevance of the observed functional benefits are questionable as is the use of the shoulder outcome scores frequently employed to assess the functional outcome of clavicle fracture treatment. When operative treatment is preferred, the number needed to treat to avoid a nonunion is high.