Efort Open Reviews最新文献

{"title":"Dynamic wrist imaging using four-dimensional CT: current concepts, clinical applications, and future perspectives.","authors":"E P A van der Heijden, T Terng, M Haenen, H S Vries, S Hummelink, E H S Teule","doi":"10.1530/EOR-2026-0051","DOIUrl":"10.1530/EOR-2026-0051","url":null,"abstract":"<p><p>Carpal instability is fundamentally a dynamic disorder that may not be detected using conventional static imaging modalities such as radiography, CT, and MRI. This diagnostic limitation may delay diagnosis and treatment, potentially leading to progressive instability and degenerative changes. Four-dimensional CT enables dynamic, in vivo visualisation and quantitative analysis of wrist kinematics by acquiring sequential volumetric datasets during active motion. This allows identification of abnormal motion patterns, including altered intercarpal coordination and subluxations, which cannot be detected using static imaging. Clinical applications include evaluation of scapholunate instability, distal radioulnar joint instability, midcarpal instability, and altered carpal kinematics in conditions such as Kienböck disease. Four-dimensional CT may also be valuable for preoperative planning and postoperative assessment by enabling objective evaluation of treatment-related changes in wrist motion. Comparison with the contralateral wrist provides an internal physiological reference and may improve diagnostic confidence by distinguishing pathological motion from normal anatomical variation. Four-dimensional CT complements conventional imaging and arthroscopy by providing functional information on wrist biomechanics. It should be used selectively when dynamic instability is suspected and conventional imaging is inconclusive. Ongoing advances in automated analysis, dose optimisation, and protocol standardisation are expected to further improve clinical applicability and support broader integration into clinical practice.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 5","pages":"381-389"},"PeriodicalIF":4.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiligament-injured knee: what the general orthopedic surgeon should know.","authors":"Michael Hantes, Vasileios Raoulis, Aristeidis Zibis, Nikolaos Metaxiotis, Artemis Hante, Nikolaos Stefanou, Vasileios S Akrivos","doi":"10.1530/EOR-2026-0053","DOIUrl":"10.1530/EOR-2026-0053","url":null,"abstract":"<p><p>Multiligament knee injuries (MLKIs) are rare but severe injuries involving bicruciate or collateral ligament disruption, frequently associated with knee dislocation, fractures, and neurovascular compromise. Vascular injury occurs in a mean of approximately 18% of cases and may be present despite palpable pulses; an ankle-brachial index (ABI) < 0.9 demonstrates high sensitivity for arterial injury. Peroneal nerve injury occurs in approximately 10-40% of cases. Early recognition and structured evaluation are critical. Serial vascular examinations, selective CT angiography, and careful neurologic assessment are mandatory. General orthopedic surgeons often make the initial management decisions, and timely diagnosis, stabilization, and referral significantly influence limb salvage and long-term function. The Schenck KD classification remains standard, with recent consensus refinements to the KD V category and proposed modifiers such as '-EM' for extensor mechanism disruption. Associated meniscal, chondral, and rare entities, such as uniplanar coronal tibiofemoral subluxation, require high clinical suspicion. Knee-spanning external fixation is indicated in vascular injury, open or fracture-dislocations, soft-tissue compromise, or persistent instability, with reconstruction commonly performed later at 3-6 weeks. Current evidence shows no clear superiority of early versus delayed reconstruction in functional outcomes, although early surgery increases stiffness risk. Anatomic reconstruction is generally favored over repair for high-grade PLC and MCL injuries due to lower failure and complication rates. At 2 years, patients retain approximately 80-85% of knee function; however, a gradual functional decline over time is observed. Arthrofibrosis (≈10%) remains the most common complication.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 5","pages":"426-436"},"PeriodicalIF":4.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Kinesio taping an effective approach for acute ankle sprains? A systematic review and meta-analysis.","authors":"Huiwu Zuo, Meng Zhang, Peng Chen, Ling Wang, Luyu Diao, Li Zhang","doi":"10.1530/EOR-2025-0034","DOIUrl":"10.1530/EOR-2025-0034","url":null,"abstract":"<p><strong>Purpose: </strong>To examine the effect of Kinesio taping (KT) on patients with acute ankle sprains (AAS).</p><p><strong>Methods: </strong>We searched MEDLINE (via PubMed), Cochrane Library, Embase, Web of Science, SPORTDiscus, CINAHL, and Google Scholar for all relevant publications from database inception to January 2025, without language restriction. Randomized controlled trials on KT for AAS were selected according to the participant, intervention, comparison, and outcome measures. A meta-analysis was conducted using R software. Heterogeneity investigation involved sensitivity, subgroup, and meta-regression analysis. Two independent reviewers assessed the quality of the literature using the Cochrane risk of bias tool 2, and the GRADE framework was applied to grade the certainty of the evidence.</p><p><strong>Results: </strong>Eight trials containing 582 participants were selected in this review. Moderate-certainty evidence indicated that KT was more effective than controls in relieving pain (standard mean difference (SMD) = -0.63; 95% CI: -1.25 to -0.01; I2 = 94.1%, P = 0.047) and improving function (SMD = 0.72; 95% CI: 0.10-1.34; I2 = 94.5%, P = 0.023). Low-certainty evidence was found for its effect on reducing swelling (SMD = -0.29; 95% CI: -0.48 to -0.10; I2 = 77.5%, P = 0.002). Subgroup analysis revealed that KT significantly improved pain, swelling, and function following 3-5 days of intervention. 'I'-shaped KT was found to significantly improve pain, swelling, and function.</p><p><strong>Conclusion: </strong>KT can significantly alleviate pain, reduce swelling, and improve function in patients with AAS. However, significant effects are only observed short-term, and the 'I'-shaped KT method may be the most effective recommendation for AAS.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 4","pages":"250-258"},"PeriodicalIF":4.6,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13087871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methods of nerve mapping to prevent iatrogenic nerve injuries during ankle arthroscopy: scoping review.","authors":"Philippe Beaudet, Kinga Michalewska, Floris van Rooij, Mo Saffarini, Alexis Nogier","doi":"10.1530/EOR-2024-0201","DOIUrl":"10.1530/EOR-2024-0201","url":null,"abstract":"<p><p>To synthesise the literature on pre- and intra-operative nerve mapping used to prevent iatrogenic nerve injuries during ankle arthroscopy. This scoping review followed the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. A systematic search was conducted using MEDLINE and Embase on 24 July 2024. Findings extracted from eligible studies were tabulated and synthesised. The search identified 270 articles, of which 9 met inclusion/exclusion criteria and were included in the review. Two studies described a mapping technique without reporting any outcomes, and three studies evaluated mapping techniques on cadavers and four on live patients. Four studies reported on visualisation and/or palpation, one study on arthroscopic transillumination, three on ultrasound and two on near-infrared light (NIR). There were only two comparative studies that showed that pre-operative ultrasound mapping places the nerves at safer distances from the portals and that ultrasound is more effective in the identification of the superficial peroneal nerve (SPN) than visualisation and/or palpation. Visualisation and/or palpation of the SPN is the most effective in ankle maximal plantar flexion and inversion and reduces the risk of nerve injury. There was no saphenous nerve injury with percutaneous screw insertion while using NIR. A reduction in nerve injuries during ankle arthroscopy might be achievable by using pre- or intra-operative nerve mapping with visualisation and/or palpation, ultrasound or (for nerves accompanied by the veins) NIR. The limited evidence suggests that pre-operative ultrasound might be potentially the most effective mapping method, but more comparative and prospective studies are needed to fully confirm these findings.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 4","pages":"243-249"},"PeriodicalIF":4.6,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13087881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive arthroscopic management versus total shoulder arthroplasty and hemiarthroplasty in patients with primary glenohumeral arthritis younger than 50 years old.","authors":"Marko Nabergoj, Patrick J Denard, Philippe Collin, Alexandre Lädermann","doi":"10.1530/EOR-2023-0156","DOIUrl":"10.1530/EOR-2023-0156","url":null,"abstract":"<p><p>Glenohumeral osteoarthritis (OA) is a disabling disease that leads to poor shoulder function and pain. Primary or idiopathic osteoarthritis occurs in previously intact joints without any inciting agent. Its precise incidence is not known. If conservative treatment fails, there are a variety of surgical procedures described in the literature. Total shoulder arthroplasty (TSA) is primarily indicated in patients above 60 years old with symptomatic glenohumeral OA and intact rotator cuff and failed conservative treatment. However, it is rarely recommended to young or active patients under the age of 50 due to its increased morbidity, limited lifespan, potential for revision surgeries, and difficulty achieving the same preoperative activity level, particularly in patients with high preoperative level of activity. Comprehensive arthroscopic management (CAM), hemiarthroplasty (HA), and TSA provide good results even in the long term for treatment of primary OA in properly selected young patients. A CAM procedure seems to be a reasonable option in case of conservative treatment failure, localized cartilage defect, tendinopathy of the long head of the biceps, stiffness, inferior osteophytes, and humeral head congruity. However, in case of humeral head incongruity, large anterior osteophytes, and an intact rotator cuff, an HA or a TSA is a feasible option.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 4","pages":"328-337"},"PeriodicalIF":4.6,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13087880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence in the diagnostic imaging of developmental dysplasia of the hip: a systematic review.","authors":"Abith Ganesh Kamath, Saran Singh Gill, Hussayn Shinwari, Kapil Sugand","doi":"10.1530/EOR-2024-0165","DOIUrl":"10.1530/EOR-2024-0165","url":null,"abstract":"<p><strong>Purpose: </strong>With the increased challenges in diagnosing DDH using traditional ultrasound imaging methods, accurate diagnosis is essential. This study assesses the effectiveness of AI in the imaging-based diagnosis of DDH through a systematic review.</p><p><strong>Methods: </strong>This review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and registered in Prospero (registration ID: CRD42024563606). A comprehensive search was conducted across Ovid MEDLINE, PubMed, Embase, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews. Studies were screened using selection criteria, and quality was assessed using standardised tools. Thematic content analysis was also performed. Of the 32 studies identified, 19 were included, with 15 undergoing quantitative analysis. The main outcome measures were sensitivity, specificity, accuracy, AUROC, PPV, and NPV. Median, median absolute deviation, Bonett-Price 95% confidence intervals, maximum, minimum, and interquartile ranges were calculated and presented in a box-and-whisker diagram.</p><p><strong>Results: </strong>In the 19 included studies, the median sensitivity was 90.0% and specificity was 93.2% across 36,907 patients. Fifteen studies reported diagnostic accuracy, with a median of 92.6%. Accuracy rates ranged from 79.2 to 99%. The most common model architecture was mask R-CNN. Four studies (21%) were judged to have a high risk of bias using the QUADAS-2 tool.</p><p><strong>Conclusions: </strong>AI technologies hold significant potential for enhancing the diagnostic accuracy of DDH. However, existing variability and bias across studies highlight the need for further standardisation and validation.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 4","pages":"290-298"},"PeriodicalIF":4.6,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13087869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing the management of periprosthetic infections with artificial intelligence: current evidence and future directions.","authors":"Fanny Delaigue, Jules Descamps, David Lebeaux, Jawad Rahal, Rémy S Nizard, Pierre-Alban Bouché","doi":"10.1530/EOR-2025-0008","DOIUrl":"10.1530/EOR-2025-0008","url":null,"abstract":"<p><p>Periprosthetic joint infections (PJIs) are a serious complication in both primary arthroplasty and revision arthroplasty, posing a major challenge in orthopaedic surgery and creating a substantial financial burden. This literature review examines the current knowledge on PJI prediction, diagnosis and prognosis, with a focus on scoring systems and machine learning (ML) tools developed to improve their management. We conducted a narrative literature review by searching Medline, CENTRAL and Embase up to October 1, 2024, with independent dual-reviewer screening. Nine non-randomized studies were included, covering 297,981 prostheses and 7,190 PJIs. Two studies assessed prediction based on patient history but highlighted the need for refinement and multi-centre prospective validation. Five studies evaluated ML in diagnosis, showing promising accuracy, yet requiring broader validation in larger, more diverse clinical contexts. Two studies addressed prognosis, but models remain limited in providing individualized, treatment-specific insights. The development of ML models represents an interesting approach, given the rising prevalence of PJIs and the need for better management. However, available studies face important limitations, including small sample sizes, lack of external validation and limited transparency regarding parameters and models. To make ML tools clinically relevant, future research should prioritize external validation, larger multi-centre prospective studies and transparent reporting. Ultimately, robust ML models have the potential to enhance PJI management, improve patient outcomes and reduce healthcare costs.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 4","pages":"259-267"},"PeriodicalIF":4.6,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13087877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biopsychosocial needs and complementary treatments for patients undergoing management for periprosthetic joint infection following hip or knee arthroplasty: a systematic review.","authors":"Amarins Koster, Gesine H Seeber, Sjoukje van der Werf, Max Ettinger, Inge van den Akker-Scheek, Martin Stevens","doi":"10.1530/EOR-2025-0107","DOIUrl":"10.1530/EOR-2025-0107","url":null,"abstract":"<p><strong>Purpose: </strong>A periprosthetic joint infection (PJI) is considered the most drastic complication after hip/knee arthroplasty. Despite extensive research into PJI treatment, insights into patients' biopsychosocial needs are sparse. The aim of the current review is to provide an overview of patients' biopsychosocial needs and interventions aimed at these needs.</p><p><strong>Methods: </strong>A systematic review incorporating a comprehensive database search of seven major scientific databases. Articles were included if they reported on the biopsychosocial needs of patients with PJI and on interventions aimed at these needs. Quality of the included studies was assessed by two reviewers with the Mixed Methods Appraisal Tool. Characteristics of included studies and the associated results were extracted.</p><p><strong>Results: </strong>Of the 9,745 identified research articles, 20 were included in the review. All of the included articles reported about biopsychosocial needs, but only two (10%) of them also reported on interventions focused on these needs. Psychological needs were reported most often (n = 19, 95%), followed by physical (n = 14, 70%) and social needs (n = 8, 40%). Improving mental health was the most frequently reported psychological need (n = 13, 65%). Functional improvement emerged as the most common identified physical need (n = 12, 60%), while social support from healthcare professionals (n = 5, 25%) was the most reported social need.</p><p><strong>Conclusion: </strong>The results show a clear need for interventions on top of the primary surgical treatment for patients diagnosed with PJI, especially for psychological and physical support. Interventions targeting needs were described in only two articles (10%) in the current literature. Future studies should explore patient-centered approaches and integrate psychological and physical management into PJI treatment pathways to improve outcomes.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 4","pages":"277-289"},"PeriodicalIF":4.6,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13087874/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between preoperative hypoalbuminemia and clinical outcomes following total hip or knee arthroplasty: a systematic review and meta-analysis.","authors":"Chen Yue, Yapeng Li, Lanbo Yang, Feng Li, Xiaolong Wu, Maoxiao Ma, Jiayi Guo","doi":"10.1530/EOR-2025-0170","DOIUrl":"10.1530/EOR-2025-0170","url":null,"abstract":"<p><strong>Background: </strong>Preoperative hypoalbuminemia is common in patients undergoing total hip or knee arthroplasty (THA/TKA). While it has been linked with poorer postoperative outcomes, there remains a paucity of systematic reviews or meta-analyses dedicated to conducting a comprehensive evaluation of this issue.</p><p><strong>Methods: </strong>A comprehensive search was conducted across the PubMed, Embase, and Web of Science databases. Studies were selected and analyzed in adherence to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines, and the quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Data were extracted and subjected to meta-analysis or qualitative synthesis for outcomes. This meta-analysis was registered in the PROSPERO database (NO. CRD42024581376).</p><p><strong>Results: </strong>Fourteen studies involving 1,194,088 patients were included. Meta-analyses showed that preoperative hypoalbuminemia was associated with a greater risk of all-cause complications (OR: 2.89, 95% CI: 1.94-4.31), sepsis (OR: 2.54, 95% CI: 1.88-3.45), septic shock (OR: 3.44, 95% CI: 1.15-10.25), pneumonia (OR: 3.83, 95% CI: 3.14-4.67), urinary tract infection (OR: 1.59, 95% CI: 1.13-2.23), myocardial infarction (OR: 2.10, 95% CI: 1.47-2.98), superficial incisional infection (OR: 2.16, 95% CI: 1.56-3.00), periprosthetic joint infection (OR: 4.03, 95% CI: 2.15-7.53), wound dehiscence (OR: 1.68, 95% CI: 1.06-2.69), transfusion (OR: 1.84, 95% CI: 1.72-1.98), unplanned reoperation (OR: 1.60, 95% CI: 1.38-1.87), and mortality (OR: 7.14, 95% CI: 5.44-9.37).</p><p><strong>Conclusion: </strong>Preoperative hypoalbuminemia is associated with an increased risk of numerous types of complications, transfusion, unplanned reoperation, and mortality after THA or TKA. Therefore, presurgical protocols formulated to deal with these unfavorable clinical outcomes may pay particular attention to this specific patient group.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 4","pages":"268-276"},"PeriodicalIF":4.6,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13087879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conservative vs surgical treatment of midshaft clavicular fractures: a systematic review.","authors":"Andreas Papaleontiou, Amelia Wild, Andrea Poupard, Panteleimon Tsantanis","doi":"10.1530/EOR-2025-0005","DOIUrl":"10.1530/EOR-2025-0005","url":null,"abstract":"<p><strong>Purpose: </strong>This systematic review aimed to evaluate the effectiveness of surgical versus conservative management in terms of union rates, functional outcomes and complications.</p><p><strong>Methods: </strong>A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Randomised controlled trials published between January 2017 and November 2023 were sourced from MEDLINE, Embase, PubMed and Cochrane databases. Outcomes assessed included union rates, functional scores and complications.</p><p><strong>Results: </strong>Six trials, involving 579 patients with midshaft clavicle fractures, met the inclusion criteria. The union rate was higher in the surgical group (93.3-100%) compared to the conservative group (82-94%). Time to union was significantly shorter for surgical management in two out of three studies reporting this outcome. Shoulder scores revealed short-term improvements in surgical groups but no significant differences at 12 months or longer. Complication rates were comparable: hardware irritation was more frequent in surgical groups, while non-union was more prevalent in conservative management. Only two studies found a statistically significant difference in union rates favouring surgery.</p><p><strong>Conclusion: </strong>Surgical management offers higher union rates and faster recovery but does not demonstrate significant long-term advantages in functional outcomes compared to conservative treatment. Complication rates are similar, with distinct profiles. Clinicians should prioritise patient-centred decision-making, considering individual preferences and clinical contexts, as operative intervention may not significantly enhance long-term outcomes. Further research should perform subgroup analyses to refine management strategies.</p>","PeriodicalId":48598,"journal":{"name":"Efort Open Reviews","volume":"11 4","pages":"349-358"},"PeriodicalIF":4.6,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13087866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}