Judd 2009.

Methods	Study design: single‐centre, 2‐group, parallel‐design RCT Duration of the study: February 2001‐June 2003 Protocol was published before recruitment of participants: not reported, but no protocol was published Details of trial registration: not registered Funding sources: study authors reported no potential conflict of interest and no funding sources
Participants	Place of study: not reported, probably Hawaii Number of participants assigned: 57 participants (29 surgical; 28 conservative) Number of participants assessed: 57 participants (29 surgical; 28 conservative) Inclusion criteria Aged 17‐40 years Isolated acute, displaced or angulated closed middle third clavicle fracture Exclusion criteria Open fractures Neurological compromise Medial or lateral third clavicle fracture Age Surgical group (mean/range): 28/19‐40 years Conservative group (mean/range): 25/17‐41 years Gender of participants assigned (male/female) Surgical group: 27/2 Conservative group: 25/3 Classification of injury: not specified, just fracture pattern (comminuted and displacement/shortening fractures)
Interventions	Timing of intervention: participants were treated within 2 weeks Type of surgical intervention: open reduction and intramedullary fixation using a modified Hagie pin (Boehme 1991) Type of conservative intervention: sling for comfort, restrictions of shoulder motion as tolerated and restrictions of activities until healing of fracture occurred Rehabilitation: in both groups, gentle shoulder motion exercises and daily living activities were allowed as tolerated. After fracture healed, physical therapy with strength training and unrestricted activities were allowed. Any co‐interventions: not reported
Outcomes	Length of follow‐up: The follow‐up was 1 year Participants were evaluated at 3 and 6 weeks and at 3, 6 and 12 months Loss to follow‐up: none lost to follow‐up Primary outcomes Function or disability measured by SANE and L' Insalata shoulder score Failure of treatment Secondary outcomes: Other treatment failure measured by: cosmetic results: prominent pins Adverse events measured by: superficial and deep infection discomfort related to the implant partial, transient radial nerve injury refracture
Notes	After fracture healing, all pins were removed under local anaesthesia. Composite adverse events: surgery: local infection (n = 6); hardware prominence (n = 3); refracture (n = 2). Conservative: refracture (n = 1). In Analysis 1.14 we used event rates 6 for surgery and 1 for conservative. Cosmetic result events: surgery: prominent pins (n = 9). Conservative: deformity (n = 0). In Analysis 1.11 we used event rates 9 for surgery and 0 for conservative.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Not reported
Allocation concealment (selection bias)	Low risk	Sealed envelopes placed in a random order were used, and neither the treating surgeon nor the participant knew the intervention until the participant consented to participate in the study.
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	High risk	Missing outcome data were not balanced in numbers across intervention groups; more participants in the conservative intervention group were not assessed at all time points.
Selective reporting (reporting bias)	High risk	Function or disability was measured by non‐standard validated participant‐reported measures.
Other bias	Low risk	The study appears to be free of other potential sources of bias.