Is shortening of displaced mid-shaft clavicle fractures associated with inferior clinical outcomes following non-operative management? A systematic review

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Malik, SS, Tahir, M, Jordan, RW, Malik, SS and Saithna, A ORCID: https://orcid.org/0000-0002-2408-5307, 2019. Is shortening of displaced mid-shaft clavicle fractures associated with inferior clinical outcomes following non-operative management? A systematic review. Journal of Shoulder and Elbow Surgery, 28 (8), pp. 1626-1638. ISSN 1058-2746

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Official URL: https://doi.org/10.1016/j.jse.2018.12.017

Abstract

Background: Management of displaced mid-shaft clavicle fractures is controversial. Non-operative treatment can lead to shortening, a risk factor for non-union and poor functional outcomes. These inferior results have resulted in authors recommending surgical fixation for fractures with significant shortening. The aim of this systematic review is to analyse the effect of fracture shortening on shoulder function and non-union rate in non-operatively managed displaced mid-shaft clavicle fractures.

Methods: A review of the online databases Medline and EMBASE was conducted in accordance with the PRISMA guidelines on the 16th February 2018. The review was registered prospectively on the PROSPERO database. Clinical studies with mid-shaft clavicle fractures treated non-operatively reporting an evaluation of the degree of clavicle shortening, and either shoulder function and/or non-union were included. The studies were appraised using the Methodological index for non-randomised studies tool.

Results: The search strategy identified 16 studies eligible for inclusion. Four studies were randomised controlled trials (RCTs) and twelve were non-randomised retrospective comparative studies. Eleven of the twelve case series failed to demonstrate any correlation between shortening and shoulder outcome scores. Of the four RCTs, three reported no significant association between fracture shortening and shoulder outcome scores. The studies also failed to demonstrate a significant association between non union and the presence of clavicle shortening.

Conclusion: There is no significant association between fracture shortening and non-union rates or shoulder outcome scores in displaced mid-shaft clavicle fractures managed non-operatively.

Level of evidence: III

Item Type:	Journal article
Alternative Title:	Running title: Shortened displaced mid-shaft clavicle fractures
Publication Title:	Journal of Shoulder and Elbow Surgery
Creators:	Malik, S.S., Tahir, M., Jordan, R.W., Malik, S.S. and Saithna, A.
Publisher:	Elsevier for Mosby
Date:	August 2019
Volume:	28
Number:	8
ISSN:	1058-2746
Identifiers:	Number Type 10.1016/j.jse.2018.12.017 DOI S1058274619300059 Publisher Item Identifier
Divisions:	Schools > School of Science and Technology
Record created by:	Jonathan Gallacher
Date Added:	27 Feb 2019 15:06
Last Modified:	28 Mar 2020 03:00
URI:	https://irep.ntu.ac.uk/id/eprint/35835