Hemiarthroplasty versus reverse shoulder arthroplasty for treatment of proximal humeral fractures: a meta-analysis

Shukla, Dave R.; McAnany, Steven J.; Kim, Jun; Overley, Sam; Parsons, Bradford O.

doi:10.1016/j.jse.2015.08.030

Cited by 123 publications

(82 citation statements)

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“…Wang [7] stated that treatment with ORIF caused no significant difference in Constant score and total number of complications compared with IN. Compared with HA, Shukla [53] reported that RSA resulted in more favorable Constant scores and Zhang [8] demonstrated that RSA was associated with a lower rate of total complications. Our network analysis showed that RSA resulted in significantly higher Constant score compared with the other four interventions.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and Safety of Interventions for Treating Adults with Displaced Proximal Humeral Fracture: A Network Meta-Analysis and Systematic Review

2016

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PurposeNetwork meta-analysis (NMA) is a comparatively new evidence-based technique in medical disciplines which compares the relative benefits associated with multiple interventions and obtains hierarchies of these interventions for various treatment options. We evaluated the effectiveness and safety of open reduction and internal fixation (ORIF), hemiarthroplasty (HA), reverse shoulder arthroplasty (RSA), intramedullary nailing (IN) and non-operative treatment (NOT) of displaced proximal humeral fractures in adults using Bayesian NMA of data from clinical trials.MethodPUBMED, EMBASE and CENTRAL in July 2016 were searched and clinical trials that evaluated interventions for treating adults with displaced proximal humeral fractures were identified. Methodological qualities of studies were assessed by the Newcastle—Ottawa Scale and risk of bias using the Cochrane Collaboration tool.ResultThirty-four trials involving 2165 participants were included in the study. RSA had significantly the highest Constant score and lower total incidence of complications than ORIF, HA and IN. Moreover, RSA resulted in a lower incidence of additional surgery than ORIF and IN. The rank of treatments in terms high Constant score was: RSA, ORIF, IN, NOT and HA. The rank for reduction in total incidence of complications was: RSA, NOT, HA, IN and ORIF. For lowering the risk of additional surgery, the rank was: RSA, NOT, HA, IN and ORIF.ConclusionRSA had the highest probability for improving functional outcome and reduction in the total incidence of complications and requiring additional surgery among the five interventions for treating adults with displaced proximal humeral fracture.

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Section: Discussionmentioning

confidence: 99%

Effectiveness and Safety of Interventions for Treating Adults with Displaced Proximal Humeral Fracture: A Network Meta-Analysis and Systematic Review

2016

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“…Proximal humeral fractures (PHF) represent between 4 and 10% of all bone fractures and occur more frequently in elderly patients [18,24,39]. Their incidence is expected to increase considerably over the coming years owing to aging of the population [16,34]. Acute threeand four-part PHF can be challenging to treat, particularly if they involve the humeral head or tuberosities [9,11,21,23].…”

Section: Introductionmentioning

confidence: 99%

“…Decision-making in the treatment of PHF is influenced by different factors, including patient age and functional status, bone quality, fracture pattern, tuberosity involvement, as well as surgeon preferences [1,34]. Traditionally, when fixation is not possible because of poor bone quality and risks of nonunion or osteonecrosis, acute PHF can be managed by shoulder hemiarthroplasty (HSA; .…”

Section: Introductionmentioning

confidence: 99%

“…1; [11,34,39]). Although HSA has fewer complications and grants better function than internal fixation systems, it remains associated with inconsistent outcomes, particularly in elderly patients, owing to proximal humeral migration as well as osteolysis, malunion, nonunion, or tuberosity resorption [15,33,34,39].…”

Section: Introductionmentioning

confidence: 99%

“…Fig. 2) gained acceptance as an alternative treatment for complex PHF in elderly patients [11,15,39], because it relies on the deltoid muscle to restore shoulder function and hence circumvents poor tuberosity healing or concomitant rotator cuff tears [24,34]. Despite encouraging results, many surgeons hesitate to treat acute PHF by RSA, because it is more invasive and could lead to potentially more complications in the long term [4,7,11,15,33,34,39].…”

Section: Introductionmentioning

confidence: 99%

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