Cochrane · systematic review · CD000434
Interventions for treating proximal humeral fractures in adults
Handoll, HHG, Elliott, J, Thillemann, TM, et al. · Cochrane Database of Systematic Reviews · 2022 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
28
current version
GRADE rated
27
No studies
1
Included studies
NR
No studies 1 · 3.6%Ungraded 0 · 0%Very low 17 · 60.7%Low 6 · 21.4%Moderate 1 · 3.6%High 3 · 10.7%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Show all 2 versionsEarly versus delayed mobilisation for non‐surgically‐treated proximal humeral fractures
Population: adults with minimally displaced or displaced (2‐part or 3‐part) proximal humeral fractures treated non‐surgically (5 trials)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Self‐reported shoulder function: Croft Shoulder Disability Score (1 or more problems) Early vs delayed mobilisation | RR 0.59 [0.4, 0.88] | 1 study · 82 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Self‐reported shoulder function: DASH(0 to 100: worst outcome) Early vs delayed mobilisation | no estimate extracted | 1 study · 50 participants | Very low Downgraded: risk of bias, imprecision |
Self‐reported shoulder function: Croft Shoulder Disability Score (1 or more problems) Early vs delayed mobilisation | RR 0.73 [0.46, 1.15] | 1 study · 74 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Quality of life: EQ‐5D (0: dead to 1: best quality of life) Early vs delayed mobilisation | no estimate extracted | 1 study · 39 participants | Very low Downgraded: risk of bias, imprecision |
Mortality Early vs delayed mobilisation | no estimate extracted | 2 studies · 92 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events: shoulder complications Early vs delayed mobilisation | no estimate extracted | 4 studies · 259 participants | Very low Downgraded: risk of bias, imprecision |
Additional surgery or substantive treatment Early vs delayed mobilisation | no estimate extracted | 4 studies · 259 participants | Very low Downgraded: risk of bias, imprecision |
Surgical versus non‐surgical treatment for proximal humeral fractures
Population: (mainly older) adults with most types of displaced proximal humeral fracturesa (10 trials)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Functional scoresb(higher = better outcome) Surgical vs non‐surgical treatment | SMD 0.1 | 7 studies · 552 participants | High |
Functional scoresd(higher = better outcome) Surgical vs non‐surgical treatment | SMD 0.17 | 3 studies · 347 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Functional scoresf(higher = better outcome) Surgical vs non‐surgical treatment | SMD 0.06 | 5 studies · 423 participants | High |
Quality of life: EQ‐5D (0: dead to 1: best quality of life) Surgical vs non‐surgical treatment | MD 0.01 | 6 studies · 502 participants | High |
Mortality Surgical vs non‐surgical treatment | RR 1.35 [0.7, 2.62] | 8 studies · 646 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Additional surgery (reoperation or secondary surgery) Surgical vs non‐surgical treatment | RR 2.06 [1.21, 3.51] | 9 studies · 667 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Adverse events / complications ‐ Number of participants with complications Surgical vs non‐surgical treatment | RR 1.46 [0.92, 2.31] | 3 studies · 391 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Locking plate versus locking intramedullary nail for surgical fixation of proximal humeral fractures
Population: adults undergoing surgery for displaced proximal humeral fracturesa (4 trials)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Self‐reported shoulder function: functional scoresb(higher = better outcome) Locking plate vs locking intramedullary nail | SMD 0.15 | 4 studies · 227 participants | Low Downgraded: risk of bias, inconsistency |
Self‐reported shoulder function: DASH (0 to 100: higher = worse disability)b Locking plate vs locking intramedullary nail | no estimate extracted | 3 studies · 174 participants | Low Downgraded: risk of bias, inconsistency |
Self‐reported shoulder function: ASES (0 to 100: best outcome)b Locking plate vs locking intramedullary nail | no estimate extracted | 2 studies · 101 participants | Low Downgraded: risk of bias, imprecision |
Quality of life: SF‐36 (0 to 100: best outcome) Locking plate vs locking intramedullary nail | no estimate extracted | 1 study · 53 participants | Very low Downgraded: risk of bias, imprecision |
Mortality Locking plate vs locking intramedullary nail | no estimate extracted | 3 studies · 176 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events: number of participants with complications Locking plate vs locking intramedullary nail | RR 1.11 [0.7, 1.75] | 4 studies · 250 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Additional surgery (reoperation or secondary surgery) Locking plate vs locking intramedullary nail | RR 0.73 [0.33, 1.61] | 3 studies · 193 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Reverse total shoulder arthroplasty (RTSA) versus hemiarthroplasty for treating displaced proximal humeral fractures
Population: adults undergoing surgery for displaced proximal humeral fracturesa (2 trials)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Self‐reported shoulder function: % of normal shoulder function based on WOOS score (higher = better outcome) Reverse total shoulder arthroplasty (RTSA) vs hemiarthroplasty | no estimate extracted | 1 study · 65 participants | Very low Downgraded: risk of bias, imprecision |
Self‐reported shoulder function Reverse total shoulder arthroplasty (RTSA) vs hemiarthroplasty | no estimate extracted | NR | No studies |
Self‐reported shoulder function: QuickDASH (0 to 55: worst disability); % of normal shoulder function based on WOOS score (higher = better outcome) Reverse total shoulder arthroplasty (RTSA) vs hemiarthroplasty | no estimate extracted | 1 study · 61 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Quality of life: EQ‐5D (0: dead to 1: best quality of life) Reverse total shoulder arthroplasty (RTSA) vs hemiarthroplasty | no estimate extracted | 1 study · 83 participants | Very low Downgraded: risk of bias, imprecision |
Mortality Reverse total shoulder arthroplasty (RTSA) vs hemiarthroplasty | no estimate extracted | 2 studies · 161 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events: number of participants with complications Reverse total shoulder arthroplasty (RTSA) vs hemiarthroplasty | RR 0.36 [0.14, 0.94] | 2 studies · 160 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Additional surgery (reoperation or secondary surgery) Reverse total shoulder arthroplasty (RTSA) vs hemiarthroplasty | no estimate extracted | 2 studies · 161 participants | Very low Downgraded: risk of bias, imprecision |