Conservative treatment of middle third clavicle fractures

There is insufficient evidence 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.

A Cochrane review included 3 studies with a total of 354 subjects. Two trials (n=234) compared the figure-of-eight bandage with an arm sling. One trial found slightly higher pain levels in the bandage group at 15 days (MD 0.80, 95% CI 0.34 to 1.26; visual analogue scale), and the other trial reported greater discomfort during bandage wear. There were no significant differences in functional or other outcomes reported for either trial. The third trial (n=120) evaluated therapeutic ultrasound and found no statistically significant difference between low-intensity pulsed ultrasound and placebo in the time to clinical fracture healing (MD –0.32 days, 95% CI –5.85 to 5.21 days) nor in any of the other reported outcomes.

Comment: The quality of evidence is downgraded by limitations in study quality (lack of blinding, inadequate intention-to-treat adherence), by imprecise results (limited study size for each comparison) and by inconsistency (heterogeneity in interventions and outcomes).

Ədəbiyyat

1. Lenza M, Belloti JC, Andriolo RB, Gomes Dos Santos JB, Faloppa F. Conservative interventions for treating middle third clavicle fractures in adolescents and adults. Cochrane Database Syst Rev 2009;(2):CD007121.