Figueiredo 2008.

Methods	Study design: single‐centre, 2‐group, parallel‐design RCT Duration of the study: August 2005‐January 2007 Protocol was published before recruitment of participants: not reported, but no protocol was published Details of trial registration: not registered Funding sources: none known
Participants	Place of study: 1 centre from Taubaté, Brazil Number of participants assigned: 50 participants Number of participants assessed: 40 participants (24 surgical; 16 conservative) Inclusion criteria Aged > 18 years Healthy patients (not specified) Middle third acute clavicle fracture Displacement > 20 mm Exclusion criteria Not reported Age Surgical group (mean/SD): 28.2/8.1 years Conservative group (mean/SD): 33.2/15.1 years Gender of participants assessed (male/female) Surgical group: 19/5 Conservative group: 12/4 Classification of injury: not specified
Interventions	Timing of intervention: not reported Type of surgical intervention: open reduction with 3.5‐mm DCP plate fixation (antero‐inferior position) Type of conservative intervention: Velpeau sling for 6 weeks Rehabilitation: Surgical group: standard sling was used for comfort for 10 days, physiotherapy was not specified Conservative group: physiotherapy after 6 weeks (not specified) Any co‐interventions: not reported
Outcomes	Length of follow‐up (mean/range): 16/12‐24 months. The length of follow‐up was not pre‐specified Loss to follow‐up: 10 participants were lost to follow‐up: 6 did not attend for examination 3 did not accept the treatment after randomisation 1 died Primary outcomes Function or disability measured by UCLA score (0‐35 point scale, higher score indicates better function) Failure of treatment Secondary outcomes Other treatment failure measured by: cosmetic result: deformity, hypertrophic scar Adverse events measured by: Long‐term follow‐up: stiffness/restricted of range of shoulder movement (adhesive capsulitis) Return to previous activities: time to return to work and activities of daily living
Notes	Composite adverse events: surgery: (n = 0). Conservative: stiffness/restricted range of shoulder movement (n = 2). In Analysis 1.14 we used event rates 0 for surgery and 2 for conservative. Cosmetic result events: surgery: unsightly scar (n = 3). Conservative: deformity (n = 7). In Analysis 1.11 we used event rates 3 for surgery and 7 for conservative.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Not reported
Allocation concealment (selection bias)	Unclear risk	Not reported
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	Outcome assessors were not blinded
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	The study authors did not specify which groups the 10 participants that were lost to follow‐up belonged to
Selective reporting (reporting bias)	High risk	Pain (as primary outcome) was reported incompletely so that it cannot be entered into a meta‐analysis
Other bias	High risk	The time points of outcomes were not pre‐specified