title: Treatment of proximal humerus fractures in the elderly: a systemic review of 409 patients.
abstract: OBJECTIVE
  There is no consensus on the treatment of proximal humerus fractures in the elderly.
  
  
  METHODS
  We conducted a systematic search of the medical literature for randomized controlled trials and controlled clinical trials from 1946 to Apr 30, 2014. Predefined PICOS criteria were used to search relevant publications. We included randomized controlled trials involving 2- to 4-part proximal humerus fractures in patients over 60 years of age that compared operative treatment to any operative or nonoperative treatment, with a minimum of 20 patients in each group and a minimum follow-up of 1 year. Outcomes had to be assessed with functional or disability measures, or a quality-of-life score.
  
  
  RESULTS
  After 2 independent researchers had read 777 abstracts, 9 publications with 409 patients were accepted for the final analysis. No statistically significant differences were found between nonoperative treatment and operative treatment with a locking plate for any disability, for quality-of-life score, or for pain, in patients with 3- or 4-part fractures. In 4-part fractures, 2 trials found similar shoulder function between hemiarthroplasty and nonoperative treatment. 1 trial found slightly better health-related quality of life (higher EQ-5D scores) at 2-year follow-up after hemiarthroplasty. Complications were common in the operative treatment groups (10-29%).
  
  
  CONCLUSIONS
  Nonoperative treatment over locking plate systems and tension banding is weakly supported. 2 trials provided weak to moderate evidence that for 4-part fractures, shoulder function is not better with hemiarthroplasty than with nonoperative treatment. 1 of the trials provided limited evidence that health-related quality of life may be better at 2-year follow-up after hemiarthroplasty. There is a high risk of complications after operative treatment.
authors.affiliation: Department of Orthopaedics , Tampere University Hospital , Tampere.
authors.forename: Antti P
authors.initials: AP
authors.lastname: Launonen
authors.forename: Vesa
authors.initials: V
authors.lastname: Lepola
authors.forename: Tapio
authors.initials: T
authors.lastname: Flinkkilä
authors.forename: Minna
authors.initials: M
authors.lastname: Laitinen
authors.forename: Mika
authors.initials: M
authors.lastname: Paavola
authors.forename: Antti
authors.initials: A
authors.lastname: Malmivaara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008875:Middle Aged; D000367:Age Factors; D001860:Bone Plates; D004185:Disability Evaluation; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods; D062785:Hemiarthroplasty / Q000379:methods; D015994:Incidence; D011183:Postoperative Complications / Q000453:epidemiology; D011788:Quality of Life / Q000523:psychology; D012784:Shoulder Fractures / Q000523:psychology / Q000628:therapy; D016896:Treatment Outcome