Conservative interventions for treating middle third clavicle fractures in adolescents and adults

Background Clavicle fractures account for around 4% of all fractures. Treatment of these fractures is usually non-operative. Objectives To evaluate the effects of different methods for conservative ( non-operative) treatment for acute ( treated soon after diagnosis) middle third clavicle fractures in adolescents and adults. Search strategy We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 4), MEDLINE (from 1966), EMBASE ( from 1980), LILACS (from 1982), trial registers and reference lists of articles. No language or publication restrictions were applied. The date of last search was in December 2008. Selection criteria Randomised and quasi-randomised controlled trials testing conservative interventions for treating adolescents and adults with acute middle third clavicle fractures were considered. The primary outcomes were pain, shoulder function, health-related quality of life and time to return to previous activities. Data collection and analysis Two authors independently selected eligible trials, assessed methodological quality and cross-checked data extraction. Risk ratios and 95% confidence intervals were calculated for dichotomous variables, and mean differences and 95% confidence intervals were calculated for continuous variables. There was no pooling of data. Main results Three trials were included in this review. Two trials compared the figure-of-eight bandage with an arm sling in a total of 234 participants. Both trials were underpowered and compromised by poor methodology. One trial found slightly higher pain levels in the bandage group at 15 days ( mean difference 0.80, 95% confidence interval 0.34 to 1.26; visual analogue scale: 0 ( no pain) to 10 ( worst pain)), and the other trial reported greater discomfort during bandage wear. There were no significant differences in functional or other outcomes reported for either trial. The third trial, which evaluated therapeutic ultrasound in 120 participants, was also underpowered but had a low risk of bias. The trial found no statistically significant difference between low-intensity pulsed ultrasound and placebo in the time to clinical fracture healing ( mean difference -0.32 days, 95% CI-5.85 to 5.21 days) nor in any of the other reported outcomes. Authors' conclusions There is insufficient evidence from randomised controlled trials to determine which methods of conservative treatment are the most appropriate for acute middle third clavicle fractures in adolescents and adults. Further research is warranted.