Operative Versus Non-operative Management of Displaced Midshaft Clavicle Fractures: A Systematic Review of the Latest Literature.

Displaced midshaft clavicle fractures in adults have traditionally been managed non-operatively; however, recent literature has challenged this approach, particularly in active populations. This systematic review aims to compare functional outcomes, union rates, complication profiles, and patient satisfaction between operative and non-operative management strategies. A comprehensive search of PubMed, Embase, and the Cochrane Library was conducted in February 2025, identifying 10 eligible studies published from 2015 onwards: eight randomized controlled trials and two prospective cohort studies. Risk of bias was assessed using the Non-randomised Studies of Interventions (ROBINS-I) and Risk of Bias 2.0 (RoB2) tools. Overall, operative treatment was associated with superior early functional outcomes and more rapid radiographic union. However, long-term functional scores and patient satisfaction were comparable between groups. Surgical intervention carried a higher incidence of reoperation, primarily due to hardware irritation. These findings suggest that while operative fixation offers early clinical benefits, non-operative treatment remains a viable and effective option for many patients, particularly those with lower functional demands or contraindications to surgery. Clinical decisions should be tailored to individual patient needs, balancing short-term gains against surgical risks.