title: [Operative versus non-operative treatment for three- or four-part proximal humeral fractures in elderly patients: a meta-analysis of randomized controlled trials].
abstract: Objective:To evaluate the efficacy of operative and non-operative treatment for three- or four-part proximal humeral fractures in elderly patients by meta-analysis.Methods:The literature search was performed in Cochrance Library, Medline, Embase, SinoMed, CNKI, Wanfang data and CQVIP databases for operative and non-operative treatment of three- or four-part proximal humeral fractures in elderly patients, and searches of conference proceedings were also conducted. The data were extracted and a meta-analysis was performed using RevMan 5.3. The outcome measures included Constants score, pain and incidence rates of AVN, reoperation, osteoarthritis, nonunion.Results:Six randomized controlled trials involving 264 patients were included in the meta-analysis. The differences of Constant scores (MD=0.47, 95%CI:-4.35-5.28,P=0.85), incidence of ANV (OR=0.56, 95%CI:0.25-1.24,P=0.15), incidence of osteoarthritis (OR=0.56, 95%CI:0.19-1.68,P=0.30), incidence of nonunion (OR=0.43, 95%CI:0.13-1.43,P=0.17) between operative group and non-operative group were not statistically significant. Operative treatment was better in pain score (MD=1.01, 95%CI:0.12-1.19,P=0.03) and had statistically significant higher reoperative rate (OR=3.97, 95%CI:1.45-10.92,P=0.007).Conclusions:No evidence support that there is difference in Constant score and incidence rate of ANV, osteoarthritis, nonunion between operative and non-operative treatment for three- or four-part proximal humeral fractures in elderly patients. More high quality randomized controlled trials are required to determine which treatment is more efficient.
authors.affiliation: Orthopaedic Trauma of Orthopaedics Center, Lanzhou General Hospital of PLA, Lanzhou 730050, China.
authors.forename: Wenbo
authors.initials: W
authors.lastname: Li
authors.affiliation: School of Public Health, Gansu University of Traditional Chinese Medicine, Lanzhou 730000, China.
authors.forename: Gaoheng
authors.initials: G
authors.lastname: Ding
authors.affiliation: Orthopaedic Trauma of Orthopaedics Center, Lanzhou General Hospital of PLA, Lanzhou 730050, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Liu
authors.affiliation: Orthopaedic Trauma of Orthopaedics Center, Lanzhou General Hospital of PLA, Lanzhou 730050, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Shi
authors.affiliation: Orthopaedic Trauma of Orthopaedics Center, Lanzhou General Hospital of PLA, Lanzhou 730050, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Orthopaedic Trauma of Orthopaedics Center, Lanzhou General Hospital of PLA, Lanzhou 730050, China. gaoqm001@sohu.com.
authors.forename: Qiuming
authors.initials: Q
authors.lastname: Gao
mesh_terms: D000368:Aged; D057186:Comparative Effectiveness Research; D017102:Fracture Healing; D000069076:Fractures, Multiple / Q000150:complications* / Q000628:therapy*; D005599:Fractures, Ununited / Q000453:epidemiology; D006801:Humans; D006811:Humerus / Q000293:injuries* / Q000601:surgery; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000379:methods* / Q000706:statistics & numerical data*; D010003:Osteoarthritis / Q000453:epidemiology; D010020:Osteonecrosis / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D012086:Reoperation / Q000706:statistics & numerical data; D012784:Shoulder Fractures / Q000150:complications* / Q000628:therapy*; D016896:Treatment Outcome