Primary Shoulder Arthroplasty Versus Conservative Treatment for Comminuted Proximal Humeral Fractures: A Systematic Literature Review

Abstract

Abstract:The objective was to identify whether arthroplasty or conservative treatment is the best available treatment for three-and four-part proximal humeral fractures by analyzing the outcome measure of the Constant score. We conducted an electronic search. The systematic review included 33 studies encompassing 1096 patients with three-or four-part proximal humeral fractures that used the Constant score as outcome measure. The mean Constant score in the conservative group was 66.5 and in the arthroplasty group was 55.5. The difference could be attributed to selection bias, unreliable classification of the fractures and inter-observer differences in the assessment of the Constant score.

Comparison of Surgical versus Non-Surgical Treatment of Displaced 3- and 4-Part Fractures of the Proximal Humerus: A Meta-Analysis

“…An additional meta-analysis based on 610 participants in 12 studies, however, showed that displaced proximal humeral fractures demonstrated improved constant scores when treated with joint-preserving options [39], although significant heterogeneity was noted among the studies analyzed. Similar results were noted in a systematic review of 33 studies encompassing 1,096 patients with 3-or 4-part proximal humeral fractures using the CMS as an outcome measure [40]. Den Hartog et al found better CMS scores in the nonoperative group compared with the operative group.…”

“…In that review, the mean CMS was 66.5 in the nonoperative group and 55.5 in the arthroplasty group. However, their discrepant results may be due to selection bias, unreliable classification of fractures, or inter-observer differences in the assessment of CMS [40]. An alternative explanation for their findings may be related to the manner whereby the tuberosities were reconstructed in the operative group.…”

The reliability and reproducibility of the Hertel classification for comminuted proximal humeral fractures compared with the Neer classification

“…1 Besides the impact of these fractures on health and quality of life, they also impose an economic burden on the society. [2][3][4][5][6] The most important determinants for treatment choice include age, co-morbidities, functional demand, surgical expertise, and the personality of the fracture. 7 Approximately eighty percent of the proximal humeral fractures are minimal or non-displaced fractures which can be treated conservatively.…”

Evolution of treatment of of the proximal humerus fractures (review)

“…D. den Hartog в 2010 г. опубликовал результаты метаанализа 33 исследований, включавших данные о результатах лечения 1096 пациентов с трех-и четырехфрагментарными переломами проксимального отдела плечевой кости. У пациентов, которым выполнялось эндопротезирование, выявлен худший функциональный результат по сравнению с неоперированными больными, с разницей в 10,9 балла по 100-балльной шкале Constant [13].…”