Reinier B Beks1, Yassine Ochen2, Herman Frima3, Diederik P J Smeeing4, Olivier van der Meijden5, Tim K Timmers6, Detlef van der Velde4, Mark van Heijl7, Luke P H Leenen8, Rolf H H Groenwold9, R Marijn Houwert2. 1. Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Utrecht Traumacenter, Utrecht, The Netherlands. Electronic address: reinierbeks@gmail.com. 2. Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Utrecht Traumacenter, Utrecht, The Netherlands. 3. Department of Surgery, Kantonsspital Graubünden, Chur, Switzerland. 4. Department of Surgery, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands. 5. Department of Orthopaedic Surgery, Spaarne Ziekenhuis, Hoofddorp, The Netherlands. 6. Department of Surgery, Meander Medisch Centrum, Amersfoort, The Netherlands. 7. Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands; Department of Surgery, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands. 8. Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. 9. Julius Center for Health Sciences, University Medical Center Utrecht, Utrecht, The Netherlands.
Abstract
BACKGROUND: There is no consensus on the choice of treatment for displaced proximal humeral fractures in older patients (aged > 65 years). The aims of this systematic review and meta-analysis were (1) to compare operative with nonoperative management of displaced proximal humeral fractures and (2) to compare effect estimates obtained from randomized controlled trials (RCTs) and observational studies. METHODS: The databases of MEDLINE, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) were searched on September 5, 2017, for studies comparing operative versus nonoperative treatment of proximal humeral fractures; both RCTs and observational studies were included. The criteria of the Methodological Index for Non-Randomized Studies, a validated instrument for methodologic quality assessment, were used to assess study quality. The primary outcome measure was physical function as measured by the absolute Constant-Murley score after operative or nonoperative treatment. Secondary outcome measures were major reinterventions, nonunion, and avascular necrosis. RESULTS: We included 22 studies, comprising 7 RCTs and 15 observational studies, resulting in 1743 patients in total: 910 treated operatively and 833 nonoperatively. The average age was 68.3 years, and 75% of patients were women. There was no difference in functional outcome between operative and nonoperative treatment, with a mean difference of -0.87 (95% confidence interval, -5.13 to 3.38; P = .69; I2 = 69%). Major reinterventions occurred more often in the operative group. Pooled effects of RCTs were similar to pooled effects of observational studies for all outcome measures. CONCLUSIONS: We recommend nonoperative treatment for the average elderly patient (aged > 65 years) with a displaced proximal humeral fracture. Pooled effects of observational studies were similar to those of RCTs, and including observational studies led to more generalizable conclusions.
BACKGROUND: There is no consensus on the choice of treatment for displaced proximal humeral fractures in older patients (aged > 65 years). The aims of this systematic review and meta-analysis were (1) to compare operative with nonoperative management of displaced proximal humeral fractures and (2) to compare effect estimates obtained from randomized controlled trials (RCTs) and observational studies. METHODS: The databases of MEDLINE, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) were searched on September 5, 2017, for studies comparing operative versus nonoperative treatment of proximal humeral fractures; both RCTs and observational studies were included. The criteria of the Methodological Index for Non-Randomized Studies, a validated instrument for methodologic quality assessment, were used to assess study quality. The primary outcome measure was physical function as measured by the absolute Constant-Murley score after operative or nonoperative treatment. Secondary outcome measures were major reinterventions, nonunion, and avascular necrosis. RESULTS: We included 22 studies, comprising 7 RCTs and 15 observational studies, resulting in 1743 patients in total: 910 treated operatively and 833 nonoperatively. The average age was 68.3 years, and 75% of patients were women. There was no difference in functional outcome between operative and nonoperative treatment, with a mean difference of -0.87 (95% confidence interval, -5.13 to 3.38; P = .69; I2 = 69%). Major reinterventions occurred more often in the operative group. Pooled effects of RCTs were similar to pooled effects of observational studies for all outcome measures. CONCLUSIONS: We recommend nonoperative treatment for the average elderly patient (aged > 65 years) with a displaced proximal humeral fracture. Pooled effects of observational studies were similar to those of RCTs, and including observational studies led to more generalizable conclusions.
Authors: John M Brooks; Cole G Chapman; Sarah B Floyd; Brian K Chen; Charles A Thigpen; Michael Kissenberth Journal: BMC Med Res Methodol Date: 2022-07-11 Impact factor: 4.612
Authors: Jeanette Köppe; Josef Stolberg-Stolberg; Robert Rischen; Andreas Faldum; Michael J Raschke; J Christoph Katthagen Journal: Clin Orthop Relat Res Date: 2021-10-01 Impact factor: 4.755
Authors: Changbao Wei; Yongjun Rui; Yongwei Wu; Yunhong Ma; Ming Zhou; Yongqiang Kang; Yapeng Wang; Jun Liu Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi Date: 2020-09-15