Operative Versus Nonoperative Treatment in Complex Proximal Humeral Fractures

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Operative Versus Nonoperative Treatment in Complex Proximal Humeral Fractures

Zhi Mao, MD; Lihai Zhang, MD, PhD; Licheng Zhang, MD, PhD; Xiantao Zeng, MD; Shuo Chen, MS; Daohong Liu, MD; Zhirui Zhou, MD; Peifu Tang, MD, PhD
  • Orthopedics
  • May 2014 – Volume 37 · Issue 5: e410-e419
  • DOI: 10.3928/01477447-20140430-50


This updated meta-analysis investigated whether operative treatment is superior to nonoperative treatment in complex proximal humeral fractures. The authors searched the Cochrane Central Register of Controlled Trials, PubMed, and EMBASE. Randomized controlled trials that evaluated operative vs nonoperative treatment for exclusively 3- or 4-part proximal humeral fractures were considered. Six studies with a total of 287 patients who had proximal humeral fractures were included. According to the meta-analysis, no statistically significant differences were found between operative and nonoperative treatment in Constant-Murley shoulder scores (Constant scores); Disabilities of the Arm, Shoulder, and Hand scores; total complication events; mortality; infection; nonunion; avascular necrosis; osteoarthritis; redisplacement of fractures; or dislocation or resorption of tuberosity. For health-related quality of life, EuroQol-5D (EQ-5D) favored operative treatment, but 15D scores showed no significant difference. Compared with nonoperative treatment, open reduction and internal fixation required significantly more additional surgeries (risk ratio, 6.50; 95% confidence interval, 1.54–27.50;P=.01), and more penetrations into joint space occurred (risk ratio, 9.56; 95% confidence interval, 2.27–40.13; P=.002). The limited evidence suggests that no convincing findings support the use of either open reduction and internal fixation or hemiarthroplasty for the treatment of complex proximal humeral fractures. The findings of the current study should be interpreted cautiously because of the modest sample size and the short follow-up period.
The authors are from the Department of Orthopaedics (ZM, Lihai Zhang, Licheng Zhang, DL, PT) and the Department of Medical Information (SC), Chinese PLA General Hospital, Beijing; the Evidence-Based Medicine Center (XZ), Taihe Hospital, Hubei University of Medicine, Shiyan; and the Department of Radiation Oncology (ZZ), Cancer Hospital of Guangxi Medical University, Cancer Institute of Guangxi Zhuang Autonomous Region, Nanning, China.
Drs Mao and Lihai Zhang contributed equally to this work and should be considered as equal first authors.
The authors have no relevant financial relationships to disclose.
The authors thank Wanjie Gu, MD, Department of Anaesthesiology, First Affiliated Hospital, Guangxi Medical University; Jun Xia, Cochrane Schizophrenia Group, University of Nottingham, Nottingham, United Kingdom; and Chundng Zhang, MD, the Fourth Affiliated Hospital of China Medical University, for valuable discussions related to this study.
Correspondence should be addressed to: Peifu Tang, MD, PhD, Department of Orthopaedics, Chinese PLA General Hospital, No 28 Fuxing Rd, Beijing 100853, China ( pftang301@sina.com).
Received: May 02, 2013
Accepted: November 08, 2013