Comparison Of Surgical And Non-Surgical Treatments For 3 And 4-Part Proximal Humerus Fractures In Elderly Patients: A Network Meta-Analysis
Sebastian Orman, BS1; Jordan Murphy, BS, MS 1; Amin Mohamadi, MD2; Joseph Serino, BS1; Philip Hanna, Mb.Bch, Bao2; Ara Nazarian, PhD2; Michael J Weaver, MD2; George Dyer, MD2 ; Arvind von Keudell, MD2
1Georgetown University School of Medicine, NW, Washington DC, DC; 2Harvard University, Boston, MA
Proximal humerus fractures (PHFs) are the third most common fracture in individuals over 65. Approximately one fifth of these PHFs are Neer's 3 and 4-part fractures. Treatment strategies include non-surgical treatment (NST), open reduction internal fixation (ORIF), hemiarthroplasty (HA) and reverse total shoulder arthroplasty (rTSA). There is currently no consensus regarding the superiority of any one surgical strategy. We aimed to use Network Meta-Analysis (NMA) of randomized controlled trials (RCTs) to determine the most successful treatment for PHFs in the elderly, based on functional outcome scores as well as adverse event and additional surgery rates.
Materials and Methods:
MEDLINE, EMBASE, Web of Science, and Cochrane Central electronic databases were searched in August 2016 for RCTs comparing 3 and 4-part PHF treatments in the elderly. Quality of included studies was evaluated using the Jadad scale for RCTs and risk of bias was evaluated using the Cochrane CollaborationŐs tool.
rTSA resulted in a lower rate of adverse events and a better Combined Constant/DASH score than HA. ORIF was associated with an increased rate of additional surgery and adverse events compared to NST. NST produced similar Combined Constant/DASH scores, adverse event rates, and additional surgery rates to HA and rTSA.
NST has similar (and in some cases better) outcomes than surgical intervention and should be the preferred treatment when indicated. In cases where surgical treatment is necessary, rTSA should be preferred over HA as it produces better outcomes, lower rate of adverse events, and no difference in rate of additional surgery.
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