Comparison of Surgical versus Non-Surgical Treatment of Displaced 3- and 4-Part Fractures of the Proximal Humerus: A Meta-Analysis.
OBJECTIVE
This meta-analysis compares the clinical outcomes of surgical versus conservative treatment of displaced, 3- or 4-part, proximal humeral fractures.


METHODS
Medline, Cochrane, EMBASE, and Google Scholar were searched for studies published until October 2013, reporting functional outcomes of 3- or 4-part fractures of the proximal humerus in skeletally mature patients. Only randomized controlled trials were included. The treatments that were evaluated included non-surgical, open surgery, intramedullary pin, locking plate, arthroplasty, and minimally invasive surgical treatments. A meta-analysis was performed on the difference in functional outcomes and quality of life (QoL) between participants undergoing surgical versus non-surgical treatment.


RESULTS
Out of 254 participants in the studies who were analyzed, 127 were treated surgically. The difference in mean values of functional score showed similar results between surgical and non-surgical treatments (difference in mean values = 0.015, 95% CI = -0.232 to 0.261, p = .908).The difference in mean values of QoL showed that surgical treatment provided better post-operative QoL than non-surgical treatment (difference in mean values = 0.146, 95% CI = 0.052 to 0.240, p = .002).


CONCLUSIONS
Surgical treatment of displaced, multi-fragment fractures of the proximal humerus did not improve shoulder functional outcome, based on the Constant-Murley Score, when compared with conservative and non-surgical treatments. However, health-related QoL was significantly improved with surgical treatment compared with conservative treatment.
1Second Department of Orthopedics, Xinjiang Karamay Central Hospital, Karamay City, Xinjiang, China.
Feng
F
Mao
De-Hua
DH
Zhang
Xiao-Chun
XC
Peng
Yi
Y
Liao
D000368:Aged; D019643:Arthroplasty, Replacement; D005260:Female; D005593:Fracture Fixation, Internal / Q000706:statistics & numerical data*; D017759:Fractures, Malunited / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D007103:Immobilization / Q000706:statistics & numerical data*; D016268:Internal Fixators; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010020:Osteonecrosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D020127:Recovery of Function; D012784:Shoulder Fractures / Q000145:classification / Q000534:rehabilitation / Q000601:surgery / Q000628:therapy*; D020069:Shoulder Pain / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D015599:Trauma Severity Indices; D016896:Treatment Outcome
arthroplasty; functional outcomes; meta-analysis; proximal humeral fractures