Abstract
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.
Highlights
Fractures of the proximal humerus are the third most common in elderly patients after those of the hip and distal radius [1], accounting for 5% to 6% of all adult fractures [2]
Keywords and MeSH terms used in the search strategy included “proximal humeral fracture”, “non-operative treatment”, “open reduction and internal fixation”, “hemiarthroplasty”, “reverse shoulder arthroplasty” and “intramedullary nailing”
Ten randomized controlled trials and twenty four controlled clinical trials remained and were considered for primary relevant studies, which were all included in this Network meta-analysis (NMA)
Summary
Fractures of the proximal humerus are the third most common in elderly patients after those of the hip and distal radius [1], accounting for 5% to 6% of all adult fractures [2] Their incidence rapidly increases with age, and women are affected between two and three times as often as men [2,3,4]. Non-operative treatment (NOT) involves a period of immobilization, such as an arm sling, followed by physiotherapy and exercise. It is generally the accepted treatment option for minimally displaced fractures and often used for people with displaced fractures [3]. Previous pairwise meta-analyses [3, 5,6,7,8] could not obtain hierarchies of these treatments because some had not been compared one by one
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