Operative vs nonoperative treatment for comminuted proximal humeral fractures in elderly patients: a current metaanalysis

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