Multiple meta-analyses have been performed to compare surgical and conservative interventions for treating midshaft clavicular fractures. The purposes of this search were to conduct a systematic review of meta-analyses comparing surgical and conservative interventions for the treatment of midshaft clavicular fractures, to help decision makers interpret and choose among discordant met- analyses, and to provide treatment recommendations through the best available evidence.
Fourteen studies were identified meeting the inclusion criteria. Conservative treatment was found to result in poor clinical outcomes and a high incidence of secondary defects, including nonunion, symptomatic malunion, neurological symptoms and overall complications. Extracted data showed that 16% of nonoperative group developed a nonunion, which is significantly higher than the 1.9% rate of nonunion in the operative group. Symptomatic malunion was also significantly more common in the nonoperative group (22% in the nonoperative group versus 1.9% in the operative group). Functional outcome differences are probably multifactorial because most individuals who developed nonunion or symptomatic malunion had significantly lower outcome scores. Conservative treatment commonly leads to more instability , nonunion and malunion.