Ferran 2010.

Methods	Study design: randomised controlled trial Duration of the study: 2006‐2008 Protocol was published before recruitment of participants: not reported Details of trial registration: not reported Funding sources: no conflict of interest
Participants	Place of study: Wales, UK Number of participants assigned: 32 (17 intramedullary group; 15 plate group) Number of participants assessed: 32 (17 intramedullary group; 15 plate group) Inclusion criteria: People with isolated middle third clavicle fracture with displacement and shortening (complete overlap of bone ends or a displaced butterfly fragment) Participants had to be able to consent to the trial Exclusion criteria: Polytrauma Inability to give consent Concurrent upper limb injuries Medical contraindications to surgery People with fractures with comminution extending laterally Age (mean/range): Intramedullary group: 23.8/13‐42 years Plate group: 32.4/16‐53 years Gender (male/female): Intramedullary group: 14/3 Plate group: 13/2 Side of injury (dominant/non‐dominant): not reported Classification of injury: not reported
Interventions	Timing of intervention (mean/SD): Intramedullary group: 13.3/5.6 days Plate group: 13.3/9.1 days Intervention 1 (Intramedullary group): Open reduction and internal fixation with Rockwood Pin Intervention 2 (Plate group): Open reduction and internal fixation with superior LC‐DCP plate Rehabilitation: For both groups, participants received arm sling protection for 2 weeks postoperatively and were encouraged to perform regular pendular exercises At 2 weeks, participants initiated gleno‐humeral range of motion exercises. For the first 6 weeks, abduction and forward flexion were limited to 90°. Beyond 6 weeks, full range of gleno‐humeral motion was encouraged Any co‐interventions: not reported
Outcomes	Length of follow‐up: Total follow‐up was 12 months Participants were evaluated at 2 and 6 weeks, 3, 6, and 12 months Loss of follow‐up: 0 lost to follow‐up. Primary outcomes: Function or disability measured by Constant score and OSS Pain evaluated by Constant score for pain Failure of treatment measured by: mechanical failure (metalwork loosened) Secondary outcomes: Clinical fracture radiographic union Adverse events, measured by: wound infection symptomatic hardware hardware irritation requiring removal scars numbness
Notes	After fracture healing, all pins were removed under local anaesthesia
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	The method of generating the random sequence was not reported
Allocation concealment (selection bias)	Low risk	Opaque and sealed envelopes were used
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants and personnel were not blinded
Blinding of outcome assessment (detection bias) All outcomes	High risk	Outcomes assessors were not blinded
Incomplete outcome data (attrition bias) All outcomes	Low risk	There were no missing data
Selective reporting (reporting bias)	High risk	The authors did not report outcomes at each time point, it was unclear when the outcomes were collected
Other bias	High risk	Major baseline imbalance related to age of participants