• Chang-peng Xu, Xue Li, Zhuang Cui, Xi-cai Diao, and Bin Yu.
• Orthopaedics and Trauma, NanFang Hospital, Southern Medical University, No. 1838 Guangzhou Da Dao Bei, Guangzhou, Guangdong Province 510515, China.
• Eur J Orthop Surg Tr. 2013 Aug 1;23(6):621-9.

PurposeThis study was designed to compare clinical effectiveness of operative with nonoperative treatment for displaced midshaft clavicular fractures (DMCF).MethodsWe systematically searched electronic databases (MEDILINE, EMBASE, CLINICAL, OVID, BIOSIS and Cochrane registry of controlled clinical trials) to identify randomized controlled trials (RCTs) in which operative treatment was compared with nonoperative treatment for DMCF from 1980 to 2012. The methodologic quality of trials was assessed. Data from chosen studies were pooled with using of fixed-effects and random-effects models with mean differences and risk ratios for continuous and dichotomous variables, respectively.ResultsFour RCTs with a total of 321 patients were screened for the present study. Results showed that the operative treatment was superior to the nonoperative treatment regarding the rate of nonunion [95 % confidence interval (CI) (0.05, 0.43), P = 0.0004], malunion [95 % CI (0.06, 0.34), P < 0.00001] and overall complication [95 % CI (0.43-0.76), P = 0.0001]. Subgroup analyses of complications revealed that significant differences were existed in the incidence of neurologic symptoms [95 % CI (0.20, 0.74), P = 0.004] and dissatisfaction with appearance [95 % CI (0.19, 0.65), P = 0.001]. Lack of consistent and standardized assessment data, insufficiency analysis that carried out showed improved functional outcomes (P < 0.05) in operative treatment.ConclusionsThe available evidence suggests that the operative treatment for DMCF is associated with a lower rate of nonunion, malunion and complication than nonoperative treatment. This study supports traditional primary operative treatment for DMCF in active adults.

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