Surgical Versus Non-Surgical Management of Displaced Midshaft Clavicle Fractures: A Systematic Review and Meta-Analysis.

Displaced midshaft clavicle fractures are common, particularly among young, active adults, and while both surgical and non-surgical approaches are used, their comparative effectiveness remains debated. This systematic review and meta-analysis evaluated surgical versus non-surgical management of acute displaced midshaft clavicle fractures in adults, focusing on union rates, functional outcomes, complications, and patient satisfaction. A comprehensive search of PubMed, Scopus, Web of Science, and Google Scholar was conducted up to May 2025, including studies involving adults with acute displaced midshaft fractures that reported at least one relevant clinical outcome. Meta-analyses were performed using RevMan 5.4 (The Cochrane Collaboration, London, England, UK), with standardized mean differences (SMDs) for continuous outcomes and odds ratios (ORs) for dichotomous outcomes. Eleven studies (1,084 patients) met inclusion criteria; surgical treatment significantly reduced nonunion rates (OR: 0.23; p < 0.00001) and showed modest improvements in early shoulder function (Constant score SMD: 0.49; p = 0.05), while DASH (Disabilities of the Arm, Shoulder and Hand) scores were similar (p = 0.35). Surgery also improved cosmetic satisfaction and shortened return-to-work time, but carried higher risks of hardware-related complications and reoperation. In summary, surgical fixation provides superior early outcomes and lower nonunion rates, especially in active patients, while long-term functional results are comparable between approaches, highlighting the importance of individualized treatment decisions based on fracture characteristics, patient activity level, and preferences.