Primary Shoulder Arthroplasty Versus Conservative Treatment for Comminuted Proximal Humeral Fractures: A Systematic Literature Review~!2009-10-19~!2009-12-15~!2010-02-17~!

Dennis Den Hartog,Wim E Tuinebreijer,Jeroen De Haan,Niels W Schep

doi:10.2174/1874325001004020087

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.

Highlights

Proximal humeral fractures are one of the most frequent osteoporotic fractures in the elderly
This study found better function and less pain in the arthroplasty group
The systematic review included 33 studies encompassing 1096 patients with three- or four-part proximal humeral fractures that used the Constant score as an outcome measure [12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43]

Summary

Introduction

Proximal humeral fractures are one of the most frequent osteoporotic fractures in the elderly. In 1993, the ageadjusted incidence in the Finnish population (per 100,000 people aged 60) of proximal fractures was 106 for women and 41 for men [1]. The incidence of all humeral fractures, per 10,000 person years, in an Australian population aged 60 years was 54.8 for women and 22.6 for men [2]. In an United States Medicare population over 65 years of age, proximal humeral fractures accounted for ten percent of the fractures in this age group [3]. Risk factors for these fractures are increasing age, female gender and Caucasian race [3]. Another risk factor is osteoporosis, confirmed by femoral neck bone mineral density [2]

Results

Discussion

Conclusion