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Operative vs nonoperative management of displaced midshaft clavicle fractures: A systematic review
Abdulaziz Ahmed Munshi, Faculty of Medicine, Umm A-Qura University, Mecca 21955, Saudi Arabia
Abdulaziz Ahmed Abdulaziz, Department of Orthopedic Surgery, King Faisal Medical Complex, Taif 26522, Saudi Arabia
Husam Hasan Tamim, Department of Orthopedic Surgery, Security Forces Hospital, Makkah 24251, Saudi Arabia
Ghamid Abdulsattar Alghamdi, Department of Orthopedic Surgery, King Abdulaziz University Hospital, Jeddah 21589, Saudi Arabia
Abdalrashid Faisal Halawani, Khalid Ahmad Alnofeay, Department of Orthopedic Surgery, King Faisal Hospital, Makkah 24236, Saudi Arabia
Abdullah Hesham Alsawaf, Department of Orthopedic Surgery, King Fahad General Hospital, Jeddah 23325, Saudi Arabia
Ahmad Abdulrahman Alghamdi, Department of Orthopedic Surgery, Ministry of Health, East Jeddah Hospital, Jeddah 22253, Saudi Arabia
Abdulellah Ismail Alqurashi, Department of Orthopedic Surgery, AlNoor Specialist Hospital, Makkah 24241, Saudi Arabia
Meshal Yahya Altowairqi, Department of Orthopedic Surgery, King Abdulaziz Specialist Hospital, Taif 26521, Saudi Arabia
Co-corresponding authors: Abdulaziz Ahmed Munshi and Abdulaziz Ahmed Abdulaziz.
Author contributions: Munshi AA and Abdulaziz AA contributed to the study conception and design; Alghamdi AA, Altowairqi MY, and Tamim HH performed the data acquisition and extraction; Alsawaf AH and Halawani AF conducted the data selection and quality assessment; Munshi AA and Abdulaziz AA drafted the manuscript; Alqurashi AI, Alghamdi GA, and Alnofeay KA critically revised the manuscript for important intellectual content; Alnofeay KA provided overall supervision for the study; all authors have read and approved the final manuscript. We respectfully submit this rationale to justify designating Munshi AA and Abdulaziz AA as co-corresponding authors for manuscript. Both authors played equal, distinct, and indispensable leadership roles throughout the entire lifecycle of this systematic review. Munshi AA led the conceptual framework, protocol registration with PROSPERO, and the structural synthesis of the manuscript. Concurrently, Abdulaziz AA directed the comprehensive data matrix verification, quality and risk-of-bias assessments, and the detailed qualitative subgroup stratifications. Given the multi-center collaboration across different clinical institutions within the region, dual corresponding authorship ensures seamless administrative continuity, timely oversight during peer review, and long-term accountability for data integrity. Both authors contributed equally to drafting and revising the final manuscript, and both share full responsibility for the scientific rigor, transparency, and post-publication inquiry management for this study.
AI contribution statement: The authors declare that no artificial intelligence tools were utilized to conceptualize, analyze, or draft the scientific core of this study. The manuscript was subjected to professional medical editing by Filipodia Editing to optimize English syntax and academic readability in accordance with standard international publishing guidelines.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Abdulaziz Ahmed Munshi, MD, Faculty of Medicine, Umm A-Qura University, Al-Abdiyyah, Mecca 21955, Saudi Arabia. abdulaziza.munshi@gmail.com
Received: June 18, 2026
Revised: July 17, 2026
Accepted: August 14, 2026
Published online: September 18, 2026
Processing time: 83 Days and 21.7 Hours
Revised: July 17, 2026
Accepted: August 14, 2026
Published online: September 18, 2026
Processing time: 83 Days and 21.7 Hours
Core Tip
Core Tip: This systematic review of level I evidence evaluated operative fixation vs nonoperative management for displaced midshaft clavicle fractures in 1615 patients. Our findings demonstrate that while surgery significantly reduces the risk of nonunion and facilitates earlier functional recovery, long-term functional outcomes at 1 year are generally comparable between operative and nonoperative management. These results emphasize the need for individualized, patient-centered decision-making, particularly for active adults who prioritize a rapid return to function.