Operative versus non-operative treatment for three- or four-part proximal humeral fractures in elderly patients: a meta-analysis of randomized controlled trials

Abstract

Objective: To evaluate the efficacy of operative and non-operative treatment for three- or four-part proximal humeral fractures in elderly patients by meta-analysis. Methods: The literature search was performed in Cochrance Library, Medline, Embase, SinoMed, CNKI, Wanfang data and CQVIP databases for operative and non-operative treatment of three- or four-part proximal humeral fractures in elderly patients, and searches of conference proceedings were also conducted. The data were extracted and a meta-analysis was performed using RevMan 5.3. The outcome measures included Constants score, pain and incidence rates of AVN, reoperation, osteoarthritis, nonunion. Results: Six randomized controlled trials involving 264 patients were included in the meta-analysis. The differences of Constant scores (MD=0.47, 95% CI:-4.35-5.28, P=0.85), incidence of ANV (OR=0.56, 95% CI:0.25-1.24, P=0.15), incidence of osteoarthritis (OR=0.56, 95% CI:0.19-1.68, P=0.30), incidence of nonunion (OR=0.43, 95% CI:0.13-1.43, P=0.17) between operative group and non-operative group were not statistically significant. Operative treatment was better in pain score (MD=1.01, 95% CI:0.12-1.19, P=0.03) and had statistically significant higher reoperative rate (OR=3.97, 95% CI:1.45-10.92, P=0.007). Conclusions: No evidence support that there is difference in Constant score and incidence rate of ANV, osteoarthritis, nonunion between operative and non-operative treatment for three- or four-part proximal humeral fractures in elderly patients. More high quality randomized controlled trials are required to determine which treatment is more efficient.