Title : Surgical versus non-surgical management of displaced midshaft clavicle fractures: A systematic review and meta-analysis
Abstract:
Displaced midshaft clavicle fractures are common injuries, particularly among young, active adults. While both surgical and non-surgical approaches are widely used, their comparative effectiveness remains debated. This systematic review and meta-analysis aimed to compare surgical versus non-surgical management of displaced midshaft clavicle fractures in adults, focusing on union rates, functional outcomes, complications, and patient satisfaction.
A comprehensive search of PubMed, Scopus, Web of Science, and Google Scholar was conducted to identify comparative studies published up to May 2025. Studies were eligible if they included adult patients with acute displaced midshaft clavicle fractures and reported at least one relevant clinical outcome. Meta-analyses were performed using RevMan 5.4, calculating Standardized Mmean Differences (SMDs) for continuous variables and Odds Ratios (ORs) for dichotomous outcomes.
Eleven studies comprising 1,084 patients were included. Surgical treatment significantly reduced nonunion rates (OR: 0.23; p<0.00001) and was associated with moderately improved shoulder function based on Constant scores (SMD: 0.49; p=0.05). No significant difference was observed in DASH scores (p=0.35). Surgical management also resulted in higher cosmetic satisfaction and a faster return to work; however, it was associated with hardware-related complications and a higher reoperation rate.
Surgical fixation provides better early outcomes and lower nonunion rates in displaced midshaft clavicle fractures, particularly in active individuals. However, long-term functional outcomes appear comparable between approaches. Treatment should be individualized based on fracture characteristics, patient activity level, and preferences.
Keywords: Clavicle Fracture, Midshaft, Surgical Fixation, Non-Operative Management, Union Rate, Functional Outcome, Meta-Analysis.
