Non-surgical treatment for displaced midshaft clavicle fractures: a systematic review and meta-analysis

BACKGROUND: This review aims to synthesize current evidence by pooling patient-reported outcome measures (PROMs) and reporting pooled data on pain and complication rates after non-surgically treated displaced midshaft clavicle fractures. MATERIALS AND METHODS: PubMed (Medline), Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials databases were searched. Studies were eligible for inclusion if they were randomized controlled trials (RCTs) involving adult patients (≥ 18 years) with displaced midshaft clavicle fractures treated non-surgically. The primary outcome was to analyze PROMs at 3-month, 6-month, and 12-month follow-ups. Secondary outcomes were pain, complications, and return to work. The outcomes were synthesized and reported as the weighted mean or rate, with 95% confidence intervals (CIs). RESULTS: In total, 4,908 studies were eligible for screening. After screening and full-text review, 18 RCTs including 1,201 patients were included. For displaced midshaft fractures, the pooled DASH score was 16.1 (95% CI 11.4-20.7) at 3 months and improved to 9.9 (95% CI 5.8-13.9) at 6 months and 6.3 (95% CI 3.0-9.5) at 12 months. The pooled VAS pain score was 4.4 (95% CI 0.0-9.1) at 3 months and 2.6 (95% CI 0.0-8.8) at 12 months. The pooled rates of secondary surgery and nonunion at 12 months were 13% and 14%, respectively. CONCLUSIONS: Non-surgical treatment was associated with generally favorable functional outcomes, with substantial recovery observed by 3 months and further improvement by 6 months and only minor changes thereafter. Although secondary surgery was required in approximately 13% of patients and nonunion occurred in 14%, long-term functional outcomes were generally favorable.