Findings

What do systematic reviews say?

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Evidence found and GRADE certainty

360 questions · 375 findings · 27 reviews · Bone, Joint and Muscle Trauma

No studies found 71 · 18.9%GRADE not reported 19 · 5.1%Very low 167 · 44.5%Low 89 · 23.7%Moderate 22 · 5.9%High 7 · 1.9%

Intramedullary fixation vs open reduction and internal fixation with plate

Function (overall) Various tools · adults (aged ≥ 16 years) with acute middle third clavicle fractures

Intramedullary fixation may leads to higher function or disability (overall) Various tools (Constant score and… compared with open reduction and internal fixation with plate (low certainty).

1 finding from 1 review

Intramedullary fixation vs open reduction and internal fixation with plate

Pain ‐ using the section of Constant score Scale from 0 to 15; with 15 being the best positive score · adults (aged ≥ 16 years) with acute middle third clavicle fractures

It is very uncertain whether intramedullary fixation changes pain ‐ using the section of Constant score Scale from 0 to 15; with… compared with open reduction and internal fixation with plate (very low certainty).

1 finding from 1 review

Intramedullary fixation vs open reduction and internal fixation with plate

Treatment failure (participants who have a non‐routine secondary surgical intervention) ‐ Overall treatment failure · adults (aged ≥ 16 years) with acute middle third clavicle fractures

It is very uncertain whether intramedullary fixation changes treatment failure (participants who have a non‐routine secondary… compared with open reduction and internal fixation with plate (very low certainty).

1 finding from 1 review

Intramedullary fixation vs open reduction and internal fixation with plate

Clinical healing ‐ time to clinical/radiographic fracture consolidation (weeks) · adults (aged ≥ 16 years) with acute middle third clavicle fractures

It is very uncertain whether intramedullary fixation changes clinical healing ‐ time to clinical/radiographic fracture… compared with open reduction and internal fixation with plate (very low certainty).

1 finding from 1 review

Intramedullary fixation vs open reduction and internal fixation with plate

Adverse events ‐ total of adverse events (various: mainly infection; cosmetic result ‐ e.g. prominent metalwork ‐ and symptomatic hardware) · adults (aged ≥ 16 years) with acute middle third clavicle fractures

It is very uncertain whether intramedullary fixation changes adverse events ‐ total of adverse events (various: mainly infection;… compared with open reduction and internal fixation with plate (very low certainty).

1 finding from 1 review

Intervention not reported

Patient‐reported functional outcomes (pooled data) · individuals more than 18 years old with distal tibial metaphyseal fractures

It is very uncertain whether the intervention changes patient‐reported functional outcomes (pooled data) (very low certainty).

1 finding from 1 review

Intervention not reported

Need for a secondary/revision operation or substantive physiotherapy for adverse outcomes (e.g. non‐union, malunion or infection) · individuals more than 18 years old with distal tibial metaphyseal fractures

It is very uncertain whether the intervention changes need for a secondary/revision operation or substantive physiotherapy… (very low certainty).

1 finding from 1 review

Intervention not reported

Symptomatic non‐union or malunion, including limping 1 year · individuals more than 18 years old with distal tibial metaphyseal fractures

It is very uncertain whether the intervention changes symptomatic non‐union or malunion, including limping 1 year (very low certainty).

1 finding from 1 review

Intervention not reported

Pain (0 to 40: no pain) · individuals more than 18 years old with distal tibial metaphyseal fractures

It is very uncertain whether the intervention changes pain (0 to 40: no pain) (very low certainty).

1 finding from 1 review

Intervention not reported

Wound complications including superficial/deep wound infection and osteomyelitis 1 year · individuals more than 18 years old with distal tibial metaphyseal fractures

It is very uncertain whether the intervention changes wound complications including superficial/deep wound infection and… (very low certainty).

1 finding from 1 review

Intervention not reported

Fracture union 1 year · individuals more than 18 years old with distal tibial metaphyseal fractures

It is very uncertain whether the intervention changes fracture union 1 year (very low certainty).

1 finding from 1 review

Plate fixation vs tension band wiring

Good clinical outcome (little pain or loss of elbow motion: Helm criteria) · adults with olecranon fractures

It is very uncertain whether plate fixation changes good clinical outcome (little pain or loss of elbow motion: Helm… compared with tension band wiring (very low certainty).

1 finding from 1 review