Treatment of proximal humerus fractures in the elderly

Abstract

Background and purpose There is no consensus on the treatment of proximal humerus fractures in the elderly.Patients and methods We conducted a systematic search of the medical literature for randomized controlled trials and controlled clinical trials from 1946 to Apr 30, 2014. Predefined PICOS criteria were used to search relevant publications. We included randomized controlled trials involving 2- to 4-part proximal humerus fractures in patients over 60 years of age that compared operative treatment to any operative or nonoperative treatment, with a minimum of 20 patients in each group and a minimum follow-up of 1 year. Outcomes had to be assessed with functional or disability measures, or a quality-of-life score.Results After 2 independent researchers had read 777 abstracts, 9 publications with 409 patients were accepted for the final analysis. No statistically significant differences were found between nonoperative treatment and operative treatment with a locking plate for any disability, for quality-of-life score, or for pain, in patients with 3- or 4-part fractures. In 4-part fractures, 2 trials found similar shoulder function between hemiarthroplasty and nonoperative treatment. 1 trial found slightly better health-related quality of life (higher EQ-5D scores) at 2-year follow-up after hemiarthroplasty. Complications were common in the operative treatment groups (10–29%).Interpretation Nonoperative treatment over locking plate systems and tension banding is weakly supported. 2 trials provided weak to moderate evidence that for 4-part fractures, shoulder function is not better with hemiarthroplasty than with nonoperative treatment. 1 of the trials provided limited evidence that health-related quality of life may be better at 2-year follow-up after hemiarthroplasty. There is a high risk of complications after operative treatment.

Epidemiology of proximal humerus fractures

“…We found that the most common fixation method used was the locking plate system followed by prosthesis. As shown previously, the use of the locking plate method has increased rapidly compared to other methods, without clear evidence of its superiority [19,20,18,21]. In our sample, the most frequent fracture was two-part (62 %), which is more than twice the number in Edinburg where the one-part was leading with 49 % [9].…”

Operative repair of proximal humerus fractures in septuagenarians and octogenarians: Does chronologic age matter?

“…14,15 Largely, the data still remain equivocal, with limitations in ability to draw conclusions. 16 A recent systematic review looked to identify outcomes in non-operative treatment of proximal humerus fractures. The authors concluded that non-operative treatment can lead to satisfactory outcomes with high rates of healing, even in patients with three-and four-part fractures.…”

No differences between operative and non-operative treatments of proximal humerus fractures

“…Just recently, our study group published a meta-analysis showing no difference between non-operative treatment and surgery 2. After this meta-analysis, a novel pragmatic multicentre PROFHER study was published.…”