{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T14:17:26Z","timestamp":1781705846127,"version":"3.54.5"},"reference-count":24,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2019,3,25]],"date-time":"2019-03-25T00:00:00Z","timestamp":1553472000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PM&amp;R"],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To systematically evaluate the scientific literature examining the efficacy of nonoperative management for midshaft clavicular fractures, specifically looking at the effect of immobilization and\/or functional rehabilitation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Type<\/jats:title><jats:p>Systematic review.<\/jats:p><\/jats:sec><jats:sec><jats:title>Literature Survey<\/jats:title><jats:p>MEDLINE (PubMed), EMBASE, CINAHL databases were searched.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methodology<\/jats:title><jats:p>Inclusion criteria included adult patients enrolled in a controlled study evaluating bony healing, pain and\/or function\u2010related improvements after a strict nonoperative treatment plan for management of midshaft clavicle fractures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Synthesis<\/jats:title><jats:p>A total of 10 articles were included in the study. Only four studies contained level I evidence; four studies were prospective case series without a control, and one was a retrospective case series without a control. Half of studies used a strict immobilization period, and most utilized a period of functional rehabilitation. There were no direct comparisons between rehabilitation protocols. Studies without a strict immobilization period had a nonunion rate of 5% to 24% and residual pain in 35% to 83% of patients compared to studies with a strict immobilization period with a nonunion rate of 3% to 29% and residual pain in 14% to 49% of patients. Studies including functional rehabilitation protocol reported functional as measured by the Constant Shoulder Score of 87.8 to 96, out of a maximum of 100 representing no functional limitations, and nonunion rates of 12% to 25% compared to 81 to 85 and 3% to 29% in those without a rehabilitation protocol.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>No studies directly examine the effect of immobilization and functional rehabilitation on clinical outcomes for midshaft clavicular fractures. Future studies are needed to better elucidate the most effective treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>I<\/jats:p><\/jats:sec>","DOI":"10.1002\/pmrj.12065","type":"journal-article","created":{"date-parts":[[2019,3,25]],"date-time":"2019-03-25T20:54:17Z","timestamp":1553547257000},"page":"401-408","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Healing, Pain and Function after Midshaft Clavicular Fractures: A Systematic Review of Treatment with Immobilization and Rehabilitation"],"prefix":"10.1002","volume":"11","author":[{"given":"Michael","family":"Catapano","sequence":"first","affiliation":[{"name":"Division of Physical Medicine and Rehabilitation, Department of Medicine University of Toronto  Toronto ON Canada"},{"name":"Division of Physical Medicine and Rehabilitation, Department of Medicine Toronto Rehabilitation Institute, 550 University Ave  Toronto ON 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