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ORIF may improve
functional outcomes as compared to non surgical treatment but there remains
inconsistent evidence regarding the best treatment for displaced midshaft
clavicle fractures.
ORIF is associated with a significant reduction early functional outcomes and rate of non-union as compared to non surgical treatment in displaced midshaft clavicle fractures, according to the results of a study published in Journal of Orthopaedic Trauma. However, the incidence of late functional outcomes, pain scores and subsequent surgeries are similar for both ORIF and non surgical treatment.
Ahmed A. F. et al. and his collegues conducted a meta-analysis to compare the outcomes of open reduction and internal fixation (ORIF) and nonsurgical treatment outcomes in treatment of displaced midshaft clavicle fractures. The studies included in the meta-analysis were searched in september 2017 from Pubmed, Web of Science, MEDLINE, Cochrane Library, EMBASE and Clinical Trials.gov
Randomized controlled trials reporting shoulder functional outcomes, non union, and subsequent pain scores or surgery rates were included. Exclusion studies were studies with younger patients than 16 years, maximum follow yp less than 9 months and inaccessible full text. Extracted data constitutes first author, number of patients, publication year, number of non unions, disbilities of arm, shoulder and hand (DASH) scores, constant scores, number of subsequent surgeries and pain measured using VAS scores.
The risk ratio of non union was 0.15% in ORIF as compared to surgical treatment. DASH and constant scores were significantly better in ORIF upto 6 months. Mean differences in DASH scores was stastically insignificant in both treatments at 12 months. Constant scores remain significant in ORIF. There occurs a similarity between surgery and pain scores in both the treatment groups. There was a significant change in constant and DASH scores.
The study findings
added that beside improving functional outcomes, patients treated with ORIF had
subsequent elective plate removals and Patients treated non surgically had more
surgical fixations for nonunions, which might be demanding in both patients and
surgeons.
J Orthop Trauma.
Open Reduction and Internal Fixation versus Non-Surgical Treatment in Displaced Midshaft Clavicle Fractures: A Meta-Analysis
Ahmed; A. et al.
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