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.