Abstract:
BACKGROUND:Clavicle fractures are common, accounting for 2.6% to 4% of all fractures. Eighty per cent of clavicle fractures are located in the middle third of the clavicle. Although treatment of these fractures is usually non-surgical, displaced clavicle fractures may be considered for surgical treatment because of their greater risk of non-union. OBJECTIVES:To assess the effects (benefits and harms) of surgical versus conservative interventions for treating middle third clavicle fractures. SEARCH METHODS:We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (to December 2012), Cochrane Central Register of Controlled Trials (CENTRAL; in The Cochrane Library 2012, Issue 11), MEDLINE (1966 to December 2012), EMBASE (1980 to 2012 Week 40), LILACS (1982 to December 2012), and trial registries (December 2012). No language or publication restrictions were applied. SELECTION CRITERIA:Randomised and quasi-randomised controlled trials evaluating surgical versus conservative interventions for treating middle third of the clavicle fractures were considered. The primary outcomes were shoulder function or disability, pain and treatment failure (defined as the number of participants who had been given a non-routine secondary surgical intervention (excluding hardware removal) for symptomatic non-union, malunion or other complications). DATA COLLECTION AND ANALYSIS:At least two review authors selected eligible trials, independently assessed risk of bias and cross-checked data. Where appropriate, results of comparable trials were pooled. MAIN RESULTS:We included eight trials involving 555 participants with middle third clavicle fractures. Four studies compared plate fixation with wearing a sling and four studies compared intramedullary fixation with wearing either a sling or a figure-of-eight bandage. Almost all trials had design features that carry a high risk of bias, thus limiting the strength of their findings.Low-quality evidence from seven trials (429 participants) showed that, compared with conservative treatment, surgical treatment of acute middle third clavicle fractures may not result in a significant improvement in upper arm function at one year of more follow-up: standardised mean difference 0.46, 95% confidence interval (CI) CI -0.06 to 0.98. This corresponds to an absolute mean improvement of 3.2 points in favour of surgery (0.4 points worse to 7 points improvement) on the 100-point Constant score; this is neither clinically nor statistically significant. Low-quality evidence from seven trials (437 participants) indicates a marginal difference in the incidence of treatment failure between surgery (9/232, 3.9%) and conservative treatment (24/205, 11.7%) (risk ratio 0.38, 95% CI 0.15 to 0.99). However, this was dominated by the results of the largest trial, which had an unusually high number of symptomatic malunions in the conservative treatment group. One trial providing pain results at one-year follow-up found no difference between the two groups. No trials reported on quality of life.No significant difference between groups was noted in the pooled results for adverse events but separate analyses by type of adverse events showed that wound infection and/or dehiscence (data from three trials) and secondary surgery due to hardware complications (data from five trials) occurred only in the surgical group. Skin and nerve problems were also more common after surgical treatment, although the difference between the two groups was not statistically significant (data from four trials). Conversely, stiffness or restriction of shoulder movement was more common after conservative treatment (data from three trials). AUTHORS' CONCLUSIONS:Limited evidence is available from randomised controlled trials on the relative effectiveness of surgical versus conservative treatment for acute middle third clavicle fractures. Treatment options must be chosen on an individual patient basis, after careful consideration of the relative benefits and harms of each intervention and of patient preferences.
journal_name
Cochrane Database Syst Revjournal_title
The Cochrane database of systematic reviewsauthors
Lenza M,Buchbinder R,Johnston RV,Belloti JC,Faloppa Fdoi
10.1002/14651858.CD009363.pub2subject
Has Abstractpub_date
2013-06-06 00:00:00pages
CD009363issue
6issn
1469-493Xpub_type
杂志文章,meta分析,评审abstract:BACKGROUND:Adequate nutrients early in life promote cognitive development and are critical for proper growth and functioning. The effect of individual nutrients consumed through food is often not the same as consuming the same nutrients in supplementary form due to 'food synergy', the biological and chemical interrelat...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD012818.pub2
更新日期:2019-02-19 00:00:00
abstract:BACKGROUND:Corticosteroids have been used late in the neonatal period to treat chronic lung disease (CLD) in preterm babies, and early to try to prevent it. CLD is likely to be the result of persisting inflammation in the lung and the use of powerful anti-inflammatory drugs like dexamethasone has some rationale. Early ...
journal_title:The Cochrane database of systematic reviews
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doi:10.1002/14651858.CD001144
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abstract:BACKGROUND:Immediate delivery of the preterm fetus with suspected compromise may decrease the risk of damage due to intrauterine hypoxia. However, it may also increase the risks of prematurity. OBJECTIVES:To assess the effects of immediate versus deferred delivery of preterm babies with suspected fetal compromise on n...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD008968.pub3
更新日期:2016-07-12 00:00:00
abstract:BACKGROUND:Dental caries is one of the most common chronic diseases of childhood and is associated with adverse health and economic consequences for infants and their families. Socioeconomically disadvantaged children have a higher risk of early childhood caries (ECC). OBJECTIVES:To assess the effects of interventions...
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doi:10.1002/14651858.CD012155.pub2
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journal_title:The Cochrane database of systematic reviews
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doi:10.1002/14651858.CD001279
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abstract:BACKGROUND:Complex regional pain syndrome (CRPS) is a painful and disabling condition that usually manifests in response to trauma or surgery. When it occurs, it is associated with significant pain and disability. It is thought to arise and persist as a consequence of a maladaptive pro-inflammatory response and disturb...
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doi:10.1002/14651858.CD003978.pub2
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abstract:BACKGROUND:Low-back pain (LBP) is a common reason for consulting a general practitioner, and advice on daily activities is an important part of the primary care management of low-back pain. OBJECTIVES:To assess the effects of advice to rest in bed for patients with acute LBP or sciatica. SEARCH STRATEGY:We searched t...
journal_title:The Cochrane database of systematic reviews
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journal_title:The Cochrane database of systematic reviews
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doi:10.1002/14651858.CD006097.pub2
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journal_title:The Cochrane database of systematic reviews
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doi:10.1002/14651858.CD011024.pub2
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pub_type: 杂志文章,meta分析
doi:10.1002/14651858.CD010912.pub5
更新日期:2018-12-17 00:00:00
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abstract:BACKGROUND:Injuries are a significant public health burden and alcohol intoxication is recognised as a risk factor for injuries. There is increasing attention on supply-side interventions, which aim to modify the environment and context within which alcohol is supplied and consumed. OBJECTIVES:To quantify the effectiv...
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doi:10.1002/14651858.CD005244.pub2
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abstract:BACKGROUND:Rosacea is a common skin condition affecting the face, characterised by flushing, redness, pimples, pustules and dilated blood vessels. The eyes are often also involved. The cause of rosacea is unclear. It is a chronic disease, which can be controlled in most cases with appropriate treatment. Numerous treatm...
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abstract:BACKGROUND:Tinea capitis is a common contagious fungal infection of the scalp in children. Systemic therapy is required for treatment and to prevent spread. This is an update of the original Cochrane review. OBJECTIVES:To assess the effects of systemic antifungal drugs for tinea capitis in children. SEARCH METHODS:We...
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更新日期:2002-01-01 00:00:00