Conservative interventions for treating middle third clavicle fractures in adolescents and adults

BackgroundClavicle (collarbone) fractures account for around 4% of all fractures; treatment of these fractures is usually non-surgical (conservative). Commonly used treatments are arm slings, strapping, figure-of-eight bandages and splints.This is an update of a Cochrane review first published in 2009.ObjectivesTo evaluate the effects of different methods for conservative (non-operative) treatment for acute (treated soon after injury) middle third clavicle fractures in adolescents and adults.Search methodsWe searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials (2013, Issue 12), MEDLINE (from 1966), EMBASE (from 1980), LILACS (from 1982), trial registers, orthopaedic proceedings and reference lists of articles. We applied no language or publication restrictions. the date of the last search was 29 January 2014.Selection criteriaRandomised and quasi-randomised controlled trials testing conservative interventions for treating adolescents and adults with acute middle third clavicle fractures. the primary outcomes were shoulder function or disability, pain and treatment failure.Data collection and analysisAt least two authors selected eligible trials, independently assessed risk of bias and cross-checked data extraction. We calculated risk ratios and 95% confidence intervals for dichotomous variables, and mean differences and 95% confidence intervals for continuous variables. There was no pooling of data.Main resultsWe included three trials in this review with 354 participants. No new trials were included in this update.Very low quality evidence was available from two trials (234 participants) that compared the figure-of-eight bandage with an arm sling for treating acute middle third clavicle fractures. Both trials were underpowered and compromised by poor methodology. One trial found slightly higher pain levels in the bandage group at 15 days (mean difference 0.80, 95% confidence interval 0.34 to 1.26; visual analogue scale: 0 (no pain) to 10 (worst pain)); and the other trial reported greater discomfort during bandage wear. There were no significant differences between the two interventions in functional or other outcomes reported for either trial.Moderate quality evidence was available from the third trial (120 participants), which evaluated therapeutic ultrasound. This trial was at low risk of any type of bias but was underpowered. the trial found no statistically significant difference between low-intensity pulsed ultrasound and placebo in the time to clinical fracture healing (mean difference -0.32 days, 95% CI -5.85 to 5.21 days), nor in any of the other reported outcomes.Authors' conclusionsThere is limited evidence available from randomised controlled trials to determine which methods of conservative treatment are the most appropriate for acute middle third clavicle fractures in adolescents and adults. Further research is warranted.Universidade Federal de São Paulo, BrazilCoordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)The University of Manchester, UKHospital Israelita Albert Einstein, BrazilHosp Israelita Albert Einstein, Orthopaed & Trauma Dept, BR-05651901 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Orthopaed & Traumatol, São Paulo, BrazilUniv Estado Para, Dept Publ Hlth, Belem, Para, BrazilUniversidade Federal de São Paulo, Dept Orthopaed & Traumatol, São Paulo, BrazilWeb of Scienc