• Robbin C McKee, Daniel B Whelan, Emil H Schemitsch, and Michael D McKee.
• Division of Orthopaedics, Department of Surgery, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada. McKeeM@smh.ca
• J Bone Joint Surg Am. 2012 Apr 18;94(8):675-84.

BackgroundRecent studies have suggested benefits following primary operative fixation of substantially displaced midshaft fractures of the clavicle. We reviewed randomized clinical trials of operative versus nonoperative treatment of these fractures, and pooled the functional outcome and complication rates to arrive at summary estimates of these outcomes.MethodsA systematic review of the literature was performed to identify studies of randomized clinical trials comparing operative versus nonoperative care for displaced midshaft clavicular fractures.ResultsSix studies (n = 412 patients, mean Detsky score = 15.3) were included. The nonunion rate was higher in the nonoperatively treated patients (twenty-nine of 200) than it was in patients treated operatively (three of 212) (p = 0.001). The rate of symptomatic malunion was higher in the nonoperative group (seventeen of 200) than it was in the operative group (0 of 212) (p < 0.001).ConclusionsOperative treatment provided a significantly lower rate of nonunion and symptomatic malunion and an earlier functional return compared with nonoperative treatment. However, there is little evidence at present to show that the long-term functional outcome of operative intervention is significantly superior to nonoperative care.

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