Detaillierte Beitrags-Information
| Beitragstitel | Midshaft clavicle fractures: surgery provides better results compared with non-operative treatment. A meta-analysis. |
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| Beitragscode | P009 |
| Autoren | |
| Präsentationsform | Poster |
| Themengebiete |
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| Abstract |
Introduction: Midshaft clavicle fractures (MCFs) are one of the most common injuries in adults, representing 2-5% of all fractures. Either non-operative or surgical treatments can be used for this kind of fractures, but there is still no consensus about which method provides better results. Nonsurgical treatment was usually preferred in the past, with expectation of good outcomes and fracture union. Nonetheless, more recent studies suggested that the nonunion rate was greater than previously expected with nonsurgical treatment and, consequentially, surgical treatment has become more and more used. Methods: A systematic research of the literature was performed, following the PRISMA guidelines, on PubMed, Web of Science, and Cochrane library databases. The risk of bias was evaluated using the Cochrane collaboration “Risk of bias” tool and the quality of evidence was graded according to GRADE guidelines. RCTs investigating differences between surgery and non-operative treatment for displaced MCFs were included. The primary outcome was the nonunion rate. Other outcomes analyzed were: time to union and to return to activities, Constant score, DASH index, patients’ satisfaction, secondary operations, and complications. Results: Out of 832 records found, 14 RCTs with 1546 patients were included. A significantly lower risk ratio for nonunion of 10% (p < 0.001) favoring surgery was found. Time to union was 5.1 weeks shorter with surgery (p = 0.007).The complication rate was higher in the surgical group (31.3% vs 20.5%, p < 0.001). The shoulder function at short-term follow-up was significantly better in the surgical group (DASH index mean difference = 4.0 points), while no statistical difference was found both in the Constant score and in the DASH index at mid-term follow-up (p = 0.41 and 0.80, respectively). At long-term follow-up, both shoulder functional scores were significantly better in the surgery group: the overall Constant score mean difference was 5.3 points (p < 0.001) and DASH index mean difference was 4.3 points (p = 0.04). Conclusions: Surgical treatment of MCFs significantly reduces the nonunion rate and shortens the time to union compared to the non-operative approach and, despite a slight higher incidence of complications, leads to better shoulder functional scores both at short and long-term follow-ups. Further studies should address the clinical significance of the documented improvement. |