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
Current version onlyEarly 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 |
Summary of findings: surgical versus non‐surgical treatment for proximal humeral fractures
Population: [mainly older] adults with most types of displaced proximal humeral fractures1 (8 trials)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Functional scores2 (higher = better outcome) Summary of findings: surgical vs non‐surgical treatment | SMD 0.07 | 5 studies · 419 participants | High |
Functional scores4 (higher = better outcome) Summary of findings: surgical vs non‐surgical treatment | SMD 0.07 | 4 studies · 351 participants | High |
Quality of life assessment: EuroQol (0: dead to 1: best health) Summary of findings: surgical vs non‐surgical treatment | no estimate extracted | 4 studies · 354 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Quality of life: SF‐12 Physical Component Score (0 to 100: best) Summary of findings: surgical vs non‐surgical treatment | no estimate extracted | 1 study · 210 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Mortality Summary of findings: surgical vs non‐surgical treatment | RR 1.4 [0.69, 2.83] | 6 studies · 596 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Additional surgery (re‐operation or secondary surgery) Summary of findings: surgical vs non‐surgical treatment | RR 2.06 [1.18, 3.6] | 7 studies · 523 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Adverse events / complications ‐ Number of patients with complications Summary of findings: surgical vs non‐surgical treatment | RR 1.3 [0.8, 2.11] | 1 study · 250 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Summary of findings: early 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 (4 trials)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Shoulder disability: Croft Shoulder Disability Score ‐ Disability (1 or more problems) Summary of findings: early vs delayed mobilisation | RR 0.59 [0.4, 0.88] | 1 study · 82 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Number of treatment sessions (until independent function achieved) Summary of findings: early vs delayed mobilisation | no estimate extracted | 1 study · 86 participants | Low Downgraded: risk of bias, imprecision, indirectness |
SF‐36 scores: pain & physical dimensions ‐ all 3 dimensions 0‐100: higher scores mean better quality of life) Summary of findings: early vs delayed mobilisation | no estimate extracted | 1 study · 81 participants | Low Downgraded: risk of bias, imprecision, indirectness |
SF‐36 scores: pain & physical dimensions ‐ all 3 dimensions 0‐100: higher scores mean better quality of life) Summary of findings: early vs delayed mobilisation | no estimate extracted | 1 study · 80 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Quality of life assessment: EuroQol 5D (0: dead to 1: best health) Summary of findings: early vs delayed mobilisation | no estimate extracted | 1 study · 39 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Adverse events: Shoulder complications Summary of findings: early vs delayed mobilisation | RR 0.73 [0.15, 3.63] | 4 studies · 259 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Adverse events: Fracture displacement and non‐union Summary of findings: early vs delayed mobilisation | RR 2.2 [0.22, 22.45] | 2 studies · 106 participants | Very low Downgraded: risk of bias, imprecision, indirectness |