Evaluation of surgical and non-surgical interventions for clavicle fractures

Objective: The aim of this study was to review all systematic reviews and meta-analyses and provide an overview of the evidence of efficacy of interventions for clavicle fractures. Methods: The Cochrane Library, PubMed, MEDLINE, Chinese Biomedicine database, China Academic Journals Full-text Database, VIP Chinese Science and Technology Periodicals Database and Wanfang Database were searched for eligible studies using keywords related to clavicle fractures. The methodological quality of included studies was assessed using the AMSTAR assessment tool. Direct evidence was analyzed narratively. Randomized controlled trials were pooled again for meta-analysis. The GRADE approach was used in summary conclusions. Results: The result of pooled data showed that while operative treatment had lower nonunion and malunion rates and higher patient satisfaction than non-operative treatment modalities [RR=6.57, 95% CI (3.01, 14.35), RR=6.93, 95% CI (2.99, 16.09); RR=0.68, 95% CI (0.51, 0.90)], these 3 outcomes were based on low-quality evidence. There was no difference between dissimilar operative and dissimilar non-operative treatments. Conclusion: Operative treatment is more effective than non-operative treatment in terms of nonunion and malunion rates and patient satisfaction. As the quality of evidence comparing efficacy between intervention methods is generally low, further original studies are needed.