Are Displaced Distal Clavicle Fractures Associated With Inferior Clinical Outcomes Following Non-operative Management? A Systematic Review.
Abstract
Background: Management of displaced distal clavicle fractures remains a topic of discussion due to notoriously high non-union rates, but there is little documented in the literature as to what effect this may have on patient-reported function. The aim of this systematic review was to look at non-operative management following displaced distal clavicle fractures to determine union rates, complications and patient reported outcome measures.
Method: A review of the online databases MEDLINE and Embase was conducted, according to PRISMA guidelines. Clinical studies which included a cohort of non-operatively managed displaced distal clavicle fractures, and reported on union rate, complications, and patient-reported functional scores, were included.
Results: 11 studies were eligible for inclusion (2 randomized controlled trials, 1 prospective non-comparative cohort study, 5 retrospective comparative cohort studies, and 3 case series) with a total of 779 patients included in this review. Average union rate was 63.2% (22.2% - 94.4%) in non-operatively managed patients, compared with 96.3% (87.9% - 100%) in operatively managed patients. The Constant-Murley Score, and Disabilities of Arm, Shoulder & Hand Score were the most frequently used outcome measure tools. No study demonstrated any significant difference in any outcome measure when comparing non-operative with operative treatment. Complication rate (including non-union) in non-operatively managed patients was 45.1%, with 11.1% requiring delayed surgery. Average complication rate in the operatively managed groups was 41.2%, with 40.1% requiring a second operation.
Conclusion: Non-operative management of displaced distal clavicle fractures results in higher non-union rates, but shoulder function remains excellent, and risk of complications and delayed surgery are low. Decision-making must take into account patient factors and expectations to provide high-quality, individualized care.
Keywords: clavicle fracture; conservative management; distal clavicle; functional outcomes; lateral clavicle; non-operative management; shoulder function.
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Date
2024-01-26
Type
Article
Subject
Orthopaedics
Collections
Citation
Thurston D, Jordan RW, Thangarajah T, Haque A, Woodmass J, D'Alessandro P, Malik SS. Are Displaced Distal Clavicle Fractures Associated With Inferior Clinical Outcomes Following Non-operative Management? A Systematic Review. J Shoulder Elbow Surg. 2024 Jan 26:S1058-2746(24)00057-0. doi: 10.1016/j.jse.2023.12.006. Epub ahead of print. PMID: 38281678.
Journal / Source Title
Journal of Shoulder and Elbow Surgery
DOI
10.1016/j.jse.2023.12.006
PMID
38281678
Publisher
Elsevier