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

Song, Jingyu; Deng, Xue Feng; Wang, Yimin; Xuebing, Wang; Li, Xue; Yu, Bin

doi:10.3944/aott.2015.14.0451

Cited by 15 publications

(12 citation statements)

References 35 publications

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“…Non-displaced fractures can be successfully treated non-operatively [21], whereas optimal treatment for displaced fractures is more controversial and includes surgical and conservative management approaches. It is unclear which patients stand to benefit the most from surgical treatment [22], and surgery is associated with higher costs [23, 24], surgical and medical complications, and additional revision surgery [25] compared to conservative treatment. Traditional surgical approaches for treating PHF in the elderly included hemiarthroplasty and open reduction and internal fixation (ORIF).…”

Section: Introductionmentioning

confidence: 99%

Geographic variation in the treatment of proximal humerus fracture: an update on surgery rates and treatment consensus

et al. 2019

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BackgroundUsing a larger, more comprehensive sample, and inclusion of the reverse shoulder arthroplasty as a primary surgical approach for proximal humerus fracture, we report on geographic variation in the treatment of proximal humerus fracture in 2011 and comment on whether treatment consensus is being reached.MethodsThis was a retrospective cohort study of Medicare patients with an x-ray-confirmed diagnosis of proximal humerus fracture in 2011. Patients receiving reverse shoulder arthroplasty, hemiarthroplasty, or open reduction internal fixation within 60 days of their diagnosis were classified as surgical management patients. Unadjusted observed surgery rates and area treatment ratios adjusted for patient demographic and clinical characteristics were calculated at the hospital referral region level.ResultsAmong patients with proximal humerus fracture (N = 77,053), 15.4% received surgery and 84.6% received conservative management. Unadjusted surgery rates varied from 1.7 to 33.3% across hospital referral regions. Among patients receiving surgery, 22.3% received hemiarthroplasty, 65.8% received open reduction internal fixation, and 11.8% received reverse shoulder arthroplasty. Patients that were female, were younger, had fewer medical comorbidities, had a lower frailty index, were white, or were not dual-eligible for Medicaid during the month of their index fracture were more likely to receive surgery (p < .0001). Geographic variation in the treatment of proximal humerus fracture persisted after adjustment for patient demographic and clinical differences across local areas. Average surgery rates ranged from 9.9 to 21.2% across area treatment ratio quintiles.ConclusionsPersistent geographic variation in surgery rates for proximal humerus fracture across the USA suggests no treatment consensus has been reached.

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Section: Introductionmentioning

confidence: 99%

Geographic variation in the treatment of proximal humerus fracture: an update on surgery rates and treatment consensus

et al. 2019

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“…Only one patient reported a complication (surgical wound dehiscence), which could have been attributed this to the small sample included in the study. (25), this study suggests that the conservative approach leads to good clinical results and bone healing, and that it furthermore avoids the risks associated with surgery.…”

Section: Proximal Humeral Fracturesmentioning

confidence: 64%

Comparison between Conservative and Surgical Treatment in Proximal Humeral Fractures. A Prospective Randomized Study with 5-Years Follow-Up

Guzzini¹,

Lanzetti

Princi³

et al. 2021

Muscle Ligaments and Tendons J

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Background. There is no consensus on the optimal treatment of displaced proximal humeral fractures. The purpose of this prospective study was to present a 5-year follow-up of conservative treatment of proximal humeral fractures as compared to surgical treatment (ORIF). Materials and methods. Fifty consecutive patients with a proximal humeral fracture (Neer types 2, 3, 4; hertel types 3 through 8) were enrolled in this study and randomized in two groups: conservative treatment (group A) and open reduction and internal fixation (ORIF) with a plate (group B). Twenty patients of group A and 15 patients of group B were available for the final follow-up. All patients were clinically evaluated at 1, 3, and 12 months, and at final follow-up with physical and radiological examination, functional scores (Constant-Murley, quick DASH, ASES, SF-12), and overall satisfaction (from 1 to 4). Results. The groups were homogeneous with regard to demographic data and radiological classifications of fractures. At the final follow-up (5.21 ± 1.30 years), the Constant-Murley score was 82.0 ± 7.6 (group A) and 87.0 ± 5.4 (group B) (n.s.); quick-DASH was 8.7 ± 4.3 (group A) and 5.4 ± 0.37 (group B) (n.s.); ASES was 83.7 ± 7.0 (group A) and 96.1 ± 1.0 (group B) (p = 0.003); and SF-12 was 88.2 ± 5.9 (group A) and 90.1 ± 5 .7 (group B) (n.s.). Eighty-five percent of patients in group A and 100% in group B were satisfied or very satisfied with their results (n.s.). One patient in group B reported wound dehiscence, which was treated with medical therapy. Conclusions. Conservative treatment in proximal humeral fractures provides similar results in functional and symptom-related scores after 5 years, compared to ORIF. Indications for ORIF should be reserved only for patients with high functional demand.

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“…There is debate on operative versus non-operative treatment for proximal humeral fractures. Some previous studies have reported that patients undergoing operative treatment are more likely to have complications [6, 8, 9] and that no significant difference exists in outcomes after operative and non-operative treatment [5, 7]. Although our study was not designed to assess comparative-effectiveness of operative versus non-operative treatments for proximal humeral fractures, it provides data on complications, readmissions, in-hospital mortality, and time to revision surgery after non-operative treatment, ORIF, and arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

Readmissions, revisions, and mortality after treatment for proximal humeral fractures in three large states

Dabija

Guan

Neviaser³

et al. 2019

BMC Musculoskelet Disord

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Background Proximal humeral fractures can be treated non-operatively or operatively with open reduction and internal fixation (ORIF) and arthroplasty. Our objective was to assess practice patterns for operative and non-operative treatment of proximal humeral fractures. We also report on complications, readmissions, in-hospital mortality, and need for surgery after initial treatment of proximal humeral fractures in California, Florida, and New York. Methods The State Inpatient Databases and State Emergency Department Databases from the Healthcare Cost and Utilization Project, sponsored by the Agency for Healthcare Research and Quality, were used for the states of California (2005–2011), Florida (2005–2014), and New York (2008–2014). Data on patients with proximal humeral fractures was extracted. Patients underwent non-operative or operative (ORIF or arthroplasty) treatment at baseline and were followed for at least 4 years from the index presentation. If the patient needed subsequent surgery, time to event was calculated in days, and Kaplan-Meier survival curves were plotted. Results At the index visit, 90.3% of patients with proximal humeral fractures had non-operative treatment, 6.7% had ORIF, and 3.0% had arthroplasty. 7.6% of patients initially treated non-operatively, 6.6% initially treated with ORIF, and 7.2% initially treated with arthroplasty needed surgery during follow-up. Device complications were the primary reason for readmission in 5.3% of ORIF patients and 6.7% of arthroplasty patients (p < 0.0001). All-cause in-hospital mortality was 9.8% for patients managed non-operatively, 8.8% for ORIF, and 10.0% for arthroplasty (p = 0.003). Conclusions A majority of patients with proximal humeral fractures underwent non-operative treatment. There was a relatively high all-cause in-hospital mortality irrespective of treatment. Given the recent debate on operative versus non-operative treatment for proximal humeral fractures, our study provides valuable information on the need for revision surgery after initial treatment. The differences in rates of revision surgery between patients treated non-operatively, with ORIF, and with arthroplasty were small in magnitude. At nine years of follow-up, ORIF had the lowest probability of needing follow-up surgery, and arthroplasty had the highest.

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

Cited by 15 publications

References 35 publications

Geographic variation in the treatment of proximal humerus fracture: an update on surgery rates and treatment consensus

Geographic variation in the treatment of proximal humerus fracture: an update on surgery rates and treatment consensus

Comparison between Conservative and Surgical Treatment in Proximal Humeral Fractures. A Prospective Randomized Study with 5-Years Follow-Up

Readmissions, revisions, and mortality after treatment for proximal humeral fractures in three large states

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