Journal article
Early Versus Delayed Surgery for Midshaft Clavicle Fractures: A Systematic Review
The Iowa orthopaedic journal, Vol.43(1), pp.151-160
01/01/2023
PMCID: PMC10296473
PMID: 37383857
Appears in Diamond Open Access
Abstract
Background: Orthopaedic surgeons debate the timing of and necessity for surgical intervention when treating displaced midshaft clavicle fractures (MCFs). This systematic review evaluates the available literature regarding functional outcomes, complication rates, nonunion, and reoperation rates between patients undergoing early versus delayed surgical management of MCFs.
Methods: Search strategies were applied in PubMed (Medline), CINAHL (EBSCO), Embase (Elsevier), Sport Discus (EBSCO), and Cochrane Central Register of Controlled Trials (Wiley). Following an initial screening and full-text review, demographic and study outcome data was extracted for comparison between the early fixation and delayed fixation studies.
Results: Twenty-one studies were identified for inclusion. This resulted in 1158 patients in the early group and 44 in the delayed. Demographics were similar between groups except for a higher percentage of males in the early group (81.6% vs. 61.4%) and longer time to surgery in the delayed group (4.6 days vs. 14.5 months). Disability of the arm, shoulder, and hand scores (3.6 vs. 13.0) and Constant-Murley scores (94.0 vs. 86.0) were better in the early group. Percentages of initial surgeries resulting in complication (33.8% vs. 63.6%), nonunion (1.2% vs. 11.4%), and nonroutine reoperation (15.8% vs. 34.1%) were higher in the delayed group.
Conclusion: Outcomes of nonunion, reoperation, complications, DASH scores, and CM scores favor early surgery over delayed surgery for MCFs. However, given the small cohort of delayed patients who still achieved moderate outcomes, we recommend a shared decision-making style for treatment recommendations regarding individual patients with MCFs. Level of Evidence: II.
Details
- Title: Subtitle
- Early Versus Delayed Surgery for Midshaft Clavicle Fractures: A Systematic Review
- Creators
- Peter H. Sanchez - University of IowaIgnacio Garcia Fleury - Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USAEmily A. Parker - University of IowaJohn Davison - University of Iowa Carver College of Medicine, Iowa City, Iowa, USARobert Westermann - University of IowaBenjamin Kopp - The University of Texas at AustinMichael C. Willey - University of IowaJoseph A. Buckwalter - Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Resource Type
- Journal article
- Publication Details
- The Iowa orthopaedic journal, Vol.43(1), pp.151-160
- PMID
- 37383857
- PMCID
- PMC10296473
- NLM abbreviation
- Iowa Orthop J
- ISSN
- 1541-5457
- eISSN
- 1555-1377
- Publisher
- Dept. of Orthopaedics, The University of Iowa; United States
- Language
- English
- Date published
- 01/01/2023
- Academic Unit
- Orthopedics and Rehabilitation; Injury Prevention Research Center; Athletic Training Program
- Record Identifier
- 9984438959402771
Metrics
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