title: Operative vs non-operative management of displaced proximal humeral fractures in the elderly: A systematic review and meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  To perform a systematic review and meta-analysis comparing operative vs non-operative treatment of displaced proximal humerus fractures in elderly patients.
  
  
  METHODS
  A systematic literature search was performed using EMBASE and MEDLINE through the OVID interface, CINAHL, the Cochrane Central Register of Controlled Trials (CENTRAL), Proquest, Web of Science, SAE digital library, and Transportation Research Board's TRID database. Searches of conference proceedings were also conducted. All available randomized controlled trials comparing operative vs non-operative management of displaced three- and four-part proximal humerus fractures in elderly patients were included. The primary outcomes measures included physical function, pain, health related quality of life, mortality, and the re-operation rate.
  
  
  RESULTS
  Six randomized controlled trials (n = 287) were included. There was no statistically significant difference in function (MD = 1.72, 95%CI: -2.90-6.34, P = 0.47), as measured by the Constant score, between the operative and the non-operative treatment groups. There was no statistically significance difference in secondary outcomes of health related quality of life (standardized MD = 0.27, 95%CI: -0.05-0.59, P = 0.09), and mortality (relative risk 1.29, 95%CI: 0.50- 3.35, P = 0.60). Operative treatment had a statistically significant higher re-operation rate (relative risk 4.09, 95%CI: 1.50-11.15, P = 0.006), and statistically significant decreased pain (MD = 1.26, 95%CI: 0.02- 2.49, P = 0.05).
  
  
  CONCLUSIONS
  There is moderate quality evidence to suggest that there is no difference in functional outcomes between the two treatments. Further high quality randomized controlled trials are required to determine if certain subgroup populations benefit from surgical management.
authors.affiliation: Santa Rabi, Sheila A Sprague, Mohit Bhandari, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario L8L 8E7, Canada.
authors.forename: Santa
authors.initials: S
authors.lastname: Rabi
authors.affiliation: Santa Rabi, Sheila A Sprague, Mohit Bhandari, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario L8L 8E7, Canada.
authors.forename: Nathan
authors.initials: N
authors.lastname: Evaniew
authors.affiliation: Santa Rabi, Sheila A Sprague, Mohit Bhandari, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario L8L 8E7, Canada.
authors.forename: Sheila A
authors.initials: SA
authors.lastname: Sprague
authors.affiliation: Santa Rabi, Sheila A Sprague, Mohit Bhandari, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario L8L 8E7, Canada.
authors.forename: Mohit
authors.initials: M
authors.lastname: Bhandari
authors.affiliation: Santa Rabi, Sheila A Sprague, Mohit Bhandari, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario L8L 8E7, Canada.
authors.forename: Gerard P
authors.initials: GP
authors.lastname: Slobogean
keywords: Meta-analysis; Non-operative treatment; Operative treatment; Outcomes; Proximal humerus fracture