BACKGROUND: The objective of this systematic review was to summarize the current evidence on efficacy and safety of the various treatment options for midshaft clavicle fractures, taking into account fracture type and other variables. MATERIAL AND METHODS: A search for systematic reviews and controlled studies published between 1998 and 2009 was carried out. RESULTS: There is moderate evidence that operative treatment for midshaft clavicle fractures results in a lower rate of fracture non-union and improved patient-oriented outcome compared to non-operative treatment. However, because union rates are generally high and there are complications which are unique to surgical intervention, risks have to be considered and weighed before a decision on treatment is made. The most important risk factors for non-union are major displacement and fracture comminution. Of all surgical procedures the best evidence of efficacy is presently available for plate fixation and elastic stable intramedullary nailing. CONCLUSION: This paper presents an algorithm derived from the current evidence which may be useful for therapy decision-making in the clinical routine.
BACKGROUND: The objective of this systematic review was to summarize the current evidence on efficacy and safety of the various treatment options for midshaft clavicle fractures, taking into account fracture type and other variables. MATERIAL AND METHODS: A search for systematic reviews and controlled studies published between 1998 and 2009 was carried out. RESULTS: There is moderate evidence that operative treatment for midshaft clavicle fractures results in a lower rate of fracture non-union and improved patient-oriented outcome compared to non-operative treatment. However, because union rates are generally high and there are complications which are unique to surgical intervention, risks have to be considered and weighed before a decision on treatment is made. The most important risk factors for non-union are major displacement and fracture comminution. Of all surgical procedures the best evidence of efficacy is presently available for plate fixation and elastic stable intramedullary nailing. CONCLUSION: This paper presents an algorithm derived from the current evidence which may be useful for therapy decision-making in the clinical routine.
Authors: David Atkins; Dana Best; Peter A Briss; Martin Eccles; Yngve Falck-Ytter; Signe Flottorp; Gordon H Guyatt; Robin T Harbour; Margaret C Haugh; David Henry; Suzanne Hill; Roman Jaeschke; Gillian Leng; Alessandro Liberati; Nicola Magrini; James Mason; Philippa Middleton; Jacek Mrukowicz; Dianne O'Connell; Andrew D Oxman; Bob Phillips; Holger J Schünemann; Tessa Tan-Torres Edejer; Helena Varonen; Gunn E Vist; John W Williams; Stephanie Zaza Journal: BMJ Date: 2004-06-19
Authors: Vinzenz Smekal; Alexander Irenberger; Peter Struve; Markus Wambacher; Dietmar Krappinger; Franz Sebastian Kralinger Journal: J Orthop Trauma Date: 2009-02 Impact factor: 2.512
Authors: Umile Giuseppe Longo; Sughran Banerjee; Julie Barber; Andrew Chambler; Carlos Cobiella; Steven Corbett; Mark Crowther; Steven Drew; Andrea Francis; Marcus Lee; Nicholas Garlick; Iain Packham; Yemi Pearse; Andrew Richards; Chris Roberts; Duncan Tennent; Emily Tims; Philip Michael Ahrens Journal: Trials Date: 2011-02-28 Impact factor: 2.279