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Operative vs. nonoperative treatment for comminuted proximal humeral fractures in elderly patients: a current meta-analysis

Yıl 2015, Cilt: 49 Sayı: 4, 345 - 353, 19.08.2015

Öz

Objective: The aim of this study was to compare the effect of operative vs. nonoperative treatment for comminuted proximal humeral fractures in elderly patients regarding clinical results, complications, and additional surgeries.
Methods: Six electronic databases (Medline, Embase, Clinical, Ovid, Biosos, and Cochrane Central Register of Controlled Trials) were systematically searched to identify randomized controlled trials (RCTs). Eligible RCTs published between 1960–2012 comparing operative vs. nonoperative treatment of comminuted proximal humeral fractures were included. Trial quality was assessed using the modified Jadad scale. Data from included studies were pooled with the use of fixed-effects and random-effects models with mean difference and risk ratios for continuous and dichotomous variables, respectively. Sensitivity analysis was performed to account for bias in patient selection.
Results: Six studies matched the selection criteria, reporting on 287 patients. One hundred fourty-four patients (50.17%) were managed nonoperatively, 20 patients (6.97%) underwent tension band fixation, 55 patients (19.16%) were treated with locked plate, and 68 patients (23.69%) underwent hemiarthroplasty. Mean follow-up ranged from 12–50 months. Results showed no significant difference in post-treatment Constant scores and DASH scores, but conservative treatment showed superior results compared to operative treatment using EQ-5D™. Compared with operative treatment, nonoperative treatment led to significantly fewer complications and additional surgeries. Findings from subgroup analyses remained consistent with these outcomes when compared to nonoperative treatment with tension band fixation, locked plate fixation, and hemiarthroplasty.
Conclusion: Compared with operative treatment for closed comminuted proximal humeral fractures in elderly patients, conservative treatment can effectively reduce the risk of additional surgeries and complications. However, there is no statistical difference between operative and nonoperative treatment in terms of clinical outcomes.

 

DOI: 10.3944/AOTT.2015.14.0451

 



Kaynakça

  • Court-Brown CM, Caesar B. Epidemiology of adult frac- tures: A review. Injury 2006;37:691–7.
  • Barrett JA, Baron JA, Karagas MR, Beach ML. Fracture risk in the U.S. Medicare population. J Clin Epidemiol 1999;52:243–9.
  • Baron JA, Barrett JA, Karagas MR. The epidemiology of peripheral fractures. Bone 1996;18(3 Suppl):209–213.
  • Palvanen M, Kannus P, Niemi S, Parkkari J. Update in the epidemiology of proximal humeral fractures. Clin Orthop Relat Res 2006;442:87–92.
  • Bengnér U, Johnell O, Redlund-Johnell I. Changes in the incidence of fracture of the upper end of the humerus dur- ing a 30-year period. A study of 2125 fractures. Clin Or- thop Relat Res 1988;231:179–82.
  • Neer CS 2nd. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am 1970;52:1077–89.
  • Neer CS 2nd. Displaced proximal humeral fractures. II. Treatment of three-part and four-part displacement. J Bone Joint Surg Am 1970;52:1090–103.
  • Court-Brown CM, Garg A, McQueen MM. The epidemi- ology of proximal humeral fractures. Acta Orthop Scand 2001;72:365–71.
  • Lanting B, MacDermid J, Drosdowech D, Faber KJ. Proxi- mal humeral fractures: a systematic review of treatment modalities. J Shoulder Elbow Surg 2008;17:42–54.
  • Bhandari M, Matthys G, McKee MD; Evidence-Based Orthopaedic Trauma Working Group. Four part fractures of the proximal humerus. J Orthop Trauma 2004;18:126– 7.
  • Handoll HH, Gibson JN, Madhok R. Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev 2003:434.
  • Vallier HA. Treatment of proximal humerus fractures. J Orthop Trauma 2007;21:469–76.
  • Nho SJ, Brophy RH, Barker JU, Cornell CN, MacGillivray JD. Management of proximal humeral fractures based on current literature. J Bone Joint Surg Am 2007;89 Suppl 3:44–58.
  • Ring D. Current concepts in plate and screw fixation of osteoporotic proximal humerus fractures. Injury 2007;38 Suppl 3:59–68.
  • Resch H, Povacz P, Fröhlich R, Wambacher M. Percutane- ous fixation of three- and four-part fractures of the proxi- mal humerus. J Bone Joint Surg Br 1997;79:295–300.
  • Wall B, Walch G. Reverse shoulder arthroplasty for the treatment of proximal humeral fractures. Hand Clin 2007;23:425-30.
  • Misra A, Kapur R, Maffulli N. Complex proximal humeral fractures in adults-a systematic review of management. In- jury 2001;32:363–72.
  • Oremus M, Wolfson C, Perrault A, Demers L, Momoli F, Moride Y. Interrater reliability of the modified Jadad qual- ity scale for systematic reviews of Alzheimer’s disease drug trials. Dement Geriatr Cogn Disord 2001;12:232–6.
  • Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gİtzsche PC, Ioannidis JP, et al. The PRISMA statement for report- ing systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elabo- ration. Ann Intern Med 2009;151:65–94.
  • Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measur- ing inconsistency in meta-analyses. BMJ 2003;327:557–60.
  • LB, MC. An introduction to sensitivity analysis. 1996;41– 107.
  • Boons HW, Goosen JH, van Grinsven S, van Susante JL, van Loon CJ. Hemiarthroplasty for humeral four-part frac- tures for patients 65 years and older: a randomized con- trolled trial. Clin Orthop Relat Res 2012;470:3483-91.
  • Zyto K, Ahrengart L, Sperber A, Törnkvist H. Treatment of displaced proximal humeral fractures in elderly patients. J Bone Joint Surg Br 1997;79:412–7.
  • Olerud P, Ahrengart L, Ponzer S, Saving J, Tidermark J. Internal fixation versus nonoperative treatment of dis- placed 3-part proximal humeral fractures in elderly pa- tients: a randomized controlled trial. J Shoulder Elbow Surg 2011;20:747–55.
  • Olerud P, Ahrengart L, Ponzer S, Saving J, Tidermark J. Hemiarthroplasty versus nonoperative treatment of dis- placed 4-part proximal humeral fractures in elderly pa- tients: a randomized controlled trial. J Shoulder Elbow Surg 2011;20:1025–33.
  • Fjalestad T, Hole MØ, Hovden IA, Blücher J, Strİmsİe K. Surgical treatment with an angular stable plate for complex displaced proximal humeral fractures in elderly patients: a randomized controlled trial. J Orthop Trauma 2012;26:98–106.
  • Stableforth PG. Four-part fractures of the neck of the hu- merus. J Bone Joint Surg Br 1984;66:104–8.
  • Olerud P, Ahrengart L, Söderqvist A, Saving J, Tidermark J. Quality of life and functional outcome after a 2-part proximal humeral fracture: a prospective cohort study on 50 patients treated with a locking plate. J Shoulder Elbow Surg 2010;19:814–22.
  • Misra A, Kapur R, Maffulli N. Complex proximal humeral fractures in adults-a systematic review of management. In- jury 2001;32:363–72.
  • Kontakis G, Koutras C, Tosounidis T, Giannoudis P. Early management of proximal humeral fractures with hemi- arthroplasty: a systematic review. J Bone Joint Surg Br 2008;90:1407–13.
  • den Hartog D, de Haan J, Schep NW, Tuinebreijer WE. Primary shoulder arthroplasty versus conservative treat- ment for comminuted proximal humeral fractures: a sys- tematic literature review. Open Orthop J 2010;4:87–92.
  • Iyengar JJ, Devcic Z, Sproul RC, Feeley BT. Nonoperative treatment of proximal humerus fractures: a systematic re- view. J Orthop Trauma 2011;25:612–7.
  • Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (dis- abilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG) Am J Ind Med 1996;29:602–8.
  • Brooks R. EuroQol: the current state of play. Health Policy 1996;37:53–72.
  • PH, Aj C. Shoulder and elbow. In: Pynsent P, Fairbank J, Carr AJ, editors. Outcome messures in orthopedics and or- thopedic trauma. 2004;172–95.
  • Cofield RH. Total shoulder arthroplasty with the Neer prosthesis. J Bone Joint Surg Am 1984;66:899–906.
Yıl 2015, Cilt: 49 Sayı: 4, 345 - 353, 19.08.2015

Öz

Kaynakça

  • Court-Brown CM, Caesar B. Epidemiology of adult frac- tures: A review. Injury 2006;37:691–7.
  • Barrett JA, Baron JA, Karagas MR, Beach ML. Fracture risk in the U.S. Medicare population. J Clin Epidemiol 1999;52:243–9.
  • Baron JA, Barrett JA, Karagas MR. The epidemiology of peripheral fractures. Bone 1996;18(3 Suppl):209–213.
  • Palvanen M, Kannus P, Niemi S, Parkkari J. Update in the epidemiology of proximal humeral fractures. Clin Orthop Relat Res 2006;442:87–92.
  • Bengnér U, Johnell O, Redlund-Johnell I. Changes in the incidence of fracture of the upper end of the humerus dur- ing a 30-year period. A study of 2125 fractures. Clin Or- thop Relat Res 1988;231:179–82.
  • Neer CS 2nd. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am 1970;52:1077–89.
  • Neer CS 2nd. Displaced proximal humeral fractures. II. Treatment of three-part and four-part displacement. J Bone Joint Surg Am 1970;52:1090–103.
  • Court-Brown CM, Garg A, McQueen MM. The epidemi- ology of proximal humeral fractures. Acta Orthop Scand 2001;72:365–71.
  • Lanting B, MacDermid J, Drosdowech D, Faber KJ. Proxi- mal humeral fractures: a systematic review of treatment modalities. J Shoulder Elbow Surg 2008;17:42–54.
  • Bhandari M, Matthys G, McKee MD; Evidence-Based Orthopaedic Trauma Working Group. Four part fractures of the proximal humerus. J Orthop Trauma 2004;18:126– 7.
  • Handoll HH, Gibson JN, Madhok R. Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev 2003:434.
  • Vallier HA. Treatment of proximal humerus fractures. J Orthop Trauma 2007;21:469–76.
  • Nho SJ, Brophy RH, Barker JU, Cornell CN, MacGillivray JD. Management of proximal humeral fractures based on current literature. J Bone Joint Surg Am 2007;89 Suppl 3:44–58.
  • Ring D. Current concepts in plate and screw fixation of osteoporotic proximal humerus fractures. Injury 2007;38 Suppl 3:59–68.
  • Resch H, Povacz P, Fröhlich R, Wambacher M. Percutane- ous fixation of three- and four-part fractures of the proxi- mal humerus. J Bone Joint Surg Br 1997;79:295–300.
  • Wall B, Walch G. Reverse shoulder arthroplasty for the treatment of proximal humeral fractures. Hand Clin 2007;23:425-30.
  • Misra A, Kapur R, Maffulli N. Complex proximal humeral fractures in adults-a systematic review of management. In- jury 2001;32:363–72.
  • Oremus M, Wolfson C, Perrault A, Demers L, Momoli F, Moride Y. Interrater reliability of the modified Jadad qual- ity scale for systematic reviews of Alzheimer’s disease drug trials. Dement Geriatr Cogn Disord 2001;12:232–6.
  • Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gİtzsche PC, Ioannidis JP, et al. The PRISMA statement for report- ing systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elabo- ration. Ann Intern Med 2009;151:65–94.
  • Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measur- ing inconsistency in meta-analyses. BMJ 2003;327:557–60.
  • LB, MC. An introduction to sensitivity analysis. 1996;41– 107.
  • Boons HW, Goosen JH, van Grinsven S, van Susante JL, van Loon CJ. Hemiarthroplasty for humeral four-part frac- tures for patients 65 years and older: a randomized con- trolled trial. Clin Orthop Relat Res 2012;470:3483-91.
  • Zyto K, Ahrengart L, Sperber A, Törnkvist H. Treatment of displaced proximal humeral fractures in elderly patients. J Bone Joint Surg Br 1997;79:412–7.
  • Olerud P, Ahrengart L, Ponzer S, Saving J, Tidermark J. Internal fixation versus nonoperative treatment of dis- placed 3-part proximal humeral fractures in elderly pa- tients: a randomized controlled trial. J Shoulder Elbow Surg 2011;20:747–55.
  • Olerud P, Ahrengart L, Ponzer S, Saving J, Tidermark J. Hemiarthroplasty versus nonoperative treatment of dis- placed 4-part proximal humeral fractures in elderly pa- tients: a randomized controlled trial. J Shoulder Elbow Surg 2011;20:1025–33.
  • Fjalestad T, Hole MØ, Hovden IA, Blücher J, Strİmsİe K. Surgical treatment with an angular stable plate for complex displaced proximal humeral fractures in elderly patients: a randomized controlled trial. J Orthop Trauma 2012;26:98–106.
  • Stableforth PG. Four-part fractures of the neck of the hu- merus. J Bone Joint Surg Br 1984;66:104–8.
  • Olerud P, Ahrengart L, Söderqvist A, Saving J, Tidermark J. Quality of life and functional outcome after a 2-part proximal humeral fracture: a prospective cohort study on 50 patients treated with a locking plate. J Shoulder Elbow Surg 2010;19:814–22.
  • Misra A, Kapur R, Maffulli N. Complex proximal humeral fractures in adults-a systematic review of management. In- jury 2001;32:363–72.
  • Kontakis G, Koutras C, Tosounidis T, Giannoudis P. Early management of proximal humeral fractures with hemi- arthroplasty: a systematic review. J Bone Joint Surg Br 2008;90:1407–13.
  • den Hartog D, de Haan J, Schep NW, Tuinebreijer WE. Primary shoulder arthroplasty versus conservative treat- ment for comminuted proximal humeral fractures: a sys- tematic literature review. Open Orthop J 2010;4:87–92.
  • Iyengar JJ, Devcic Z, Sproul RC, Feeley BT. Nonoperative treatment of proximal humerus fractures: a systematic re- view. J Orthop Trauma 2011;25:612–7.
  • Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (dis- abilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG) Am J Ind Med 1996;29:602–8.
  • Brooks R. EuroQol: the current state of play. Health Policy 1996;37:53–72.
  • PH, Aj C. Shoulder and elbow. In: Pynsent P, Fairbank J, Carr AJ, editors. Outcome messures in orthopedics and or- thopedic trauma. 2004;172–95.
  • Cofield RH. Total shoulder arthroplasty with the Neer prosthesis. J Bone Joint Surg Am 1984;66:899–906.
Toplam 36 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Bölüm Orijinal Makale
Yazarlar

Jin-qi Song Bu kişi benim

Xue-feng Deng Bu kişi benim

Yi-min Wang Bu kişi benim

Xue-bing Wang Bu kişi benim

Xue Li Bu kişi benim

Bin Yu Bu kişi benim

Yayımlanma Tarihi 19 Ağustos 2015
Yayımlandığı Sayı Yıl 2015 Cilt: 49 Sayı: 4

Kaynak Göster

APA Song, J.-q., Deng, X.-f., Wang, Y.-m., Wang, X.-b., vd. (2015). Operative vs. nonoperative treatment for comminuted proximal humeral fractures in elderly patients: a current meta-analysis. Acta Orthopaedica Et Traumatologica Turcica, 49(4), 345-353. https://doi.org/10.3944/AOTT.2015.14.0451
AMA Song Jq, Deng Xf, Wang Ym, Wang Xb, Li X, Yu B. Operative vs. nonoperative treatment for comminuted proximal humeral fractures in elderly patients: a current meta-analysis. Acta Orthopaedica et Traumatologica Turcica. Ağustos 2015;49(4):345-353. doi:10.3944/AOTT.2015.14.0451
Chicago Song, Jin-qi, Xue-feng Deng, Yi-min Wang, Xue-bing Wang, Xue Li, ve Bin Yu. “Operative Vs. Nonoperative Treatment for Comminuted Proximal Humeral Fractures in Elderly Patients: A Current Meta-Analysis”. Acta Orthopaedica Et Traumatologica Turcica 49, sy. 4 (Ağustos 2015): 345-53. https://doi.org/10.3944/AOTT.2015.14.0451.
EndNote Song J-q, Deng X-f, Wang Y-m, Wang X-b, Li X, Yu B (01 Ağustos 2015) Operative vs. nonoperative treatment for comminuted proximal humeral fractures in elderly patients: a current meta-analysis. Acta Orthopaedica et Traumatologica Turcica 49 4 345–353.
IEEE J.-q. Song, X.-f. Deng, Y.-m. Wang, X.-b. Wang, X. Li, ve B. Yu, “Operative vs. nonoperative treatment for comminuted proximal humeral fractures in elderly patients: a current meta-analysis”, Acta Orthopaedica et Traumatologica Turcica, c. 49, sy. 4, ss. 345–353, 2015, doi: 10.3944/AOTT.2015.14.0451.
ISNAD Song, Jin-qi vd. “Operative Vs. Nonoperative Treatment for Comminuted Proximal Humeral Fractures in Elderly Patients: A Current Meta-Analysis”. Acta Orthopaedica et Traumatologica Turcica 49/4 (Ağustos 2015), 345-353. https://doi.org/10.3944/AOTT.2015.14.0451.
JAMA Song J-q, Deng X-f, Wang Y-m, Wang X-b, Li X, Yu B. Operative vs. nonoperative treatment for comminuted proximal humeral fractures in elderly patients: a current meta-analysis. Acta Orthopaedica et Traumatologica Turcica. 2015;49:345–353.
MLA Song, Jin-qi vd. “Operative Vs. Nonoperative Treatment for Comminuted Proximal Humeral Fractures in Elderly Patients: A Current Meta-Analysis”. Acta Orthopaedica Et Traumatologica Turcica, c. 49, sy. 4, 2015, ss. 345-53, doi:10.3944/AOTT.2015.14.0451.
Vancouver Song J-q, Deng X-f, Wang Y-m, Wang X-b, Li X, Yu B. Operative vs. nonoperative treatment for comminuted proximal humeral fractures in elderly patients: a current meta-analysis. Acta Orthopaedica et Traumatologica Turcica. 2015;49(4):345-53.