title: Surgical versus conservative treatment for displaced proximal humeral fractures in elderly patients: a meta-analysis.
abstract: OBJECTIVE
  Treatment strategies for complex displaced proximal humeral fractures (DPHF) in elderly patients remain controversial. This meta-analysis was performed to compare the benefits and risks of surgical or conservative methods for these patients.
  
  
  METHODS
  Pubmed, Cochrane library and EMBASE were systematically searched for randomized controlled trials (RCTs) from their establishment to June 2013. Researches on surgical/conservative treatment for complex displaced proximal humeral fractures in elderly patients were selected. Methodological quality of included studies was evaluated by the Physiotherapy Evidence Database (PEDro) scale. Outcome measurements were Constant score, DASH (disabilities of the arm, shoulder and hand), postoperative complications and quality of life (QoL). The meta-analysis was performed with software Stata 12.0.
  
  
  RESULTS
  Six RCTs with 272 patients were included and analyzed. Fix studies with a PEDro score of 6 or more were of high quality. The differences in QoL (WMD 0.43, 95% CI (0.12, 0.74)) and postoperative complications (RR 2.06, 95% CI (1.45, 2.93)) were statistically significant between operative and conservative treatment. There was no statistically significant difference in Constant score (WMD 0.06, 95% CI (-0.20, 0.31)) and DASH (WMD 0.33, 95% CI (-0.70, 0.04)).
  
  
  CONCLUSIONS
  Despite the small improvement of QoL, surgical treatments did not significantly improve the functional outcome including Constant score and DASH. Instead, surgical treatment for displaced proximal humeral fractures in elderly patients led to higher incidence of postoperative complications.
authors: Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan 430071, P.R. China.
authors: Tao
authors: T
authors: Fu
authors: Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan 430071, P.R. China.
authors: Chengyan
authors: C
authors: Xia
authors: Department of Orthopedics, Zhongnan Hospital of Wuhan University Wuhan 430071, P.R. China.
authors: Zonghuan
authors: Z
authors: Li
authors: Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan 430071, P.R. China.
authors: Hua
authors: H
authors: Wu
keywords: Surgical procedures; conservative; elderly; meta-analysis; proximal humeral fracture