Robinson clavicle RCT

Open reduction and plate fixation versus nonoperative treatment for displaced midshaft clavicular fractures: a multicenter, randomized, controlled trial

Robinson CM, Goudie EB, Murray IR, et al. The Journal of bone and joint surgery. American volume 2013 · PMID 24005198 · doi:10.2106/jbjs.l.00307

Question

In adults with displaced midshaft clavicle fractures, does plate fixation improve function and union compared with non-operative care?

Design

Multicentre single-blinded RCT led from Edinburgh, with CT assessment of union and economic evaluation.

Patients

Adults aged 16 to 60 with a completely displaced midshaft clavicle fracture.

Intervention

Open reduction and plate fixation

Comparison

Sling and non-operative treatment

Primary outcome

Union (on CT), DASH and Constant scores up to 1 year

Key result

Plate fixation markedly reduced non-union and gave slightly better DASH and Constant scores at 1 year, but these functional differences disappeared once patients with non-union were excluded.

Limitations

Functional gains were small and of uncertain clinical importance, and patients could not be blinded to treatment.

Impact on practice

Supports shared decision-making: fixation reduces non-union risk, but most patients do well non-operatively, so routine fixation is not required.