Meta-analysis of joint preservation versus arthroplasty for the treatment of displaced 3- and 4-part fractures of the proximal humerus.
PURPOSE
This meta-analysis compares the clinical outcomes of joint preservation versus arthroplasty in the treatment of displaced proximal humerus fractures.


METHODS
Medline, CINAHL, and EMBASE were searched for studies published between 1970 and 2011 reporting outcomes of the treatment of 3- or 4-part proximal humerus fractures using the Constant-Murley score in skeletally mature patients. Randomised and cohort studies with ≥ 1-year follow-up were included. Two individuals independently extracted data, and study results were divided into subgroups based on type of treatment.


RESULTS
A meta-analysis with meta regressions was performed on the mean Constant score. Of 610 total participants in the studies analysed, 340 were treated with joint-preserving techniques. The random-effects mean Constant score across all treatment types was 62.7 (95% CI, 61.6-63.9, P<0.001), with joint-preserving treatments demonstrating higher scores than arthroplasty (70 vs. 49, P<0.001). The studies displayed significant heterogeneity (Q statistic=516, P<0.001, I(2)=94.8). In the meta-regression analyses, Constant scores decreased significantly with increasing age, fracture severity, and rate of osteonecrosis (P<0.001).


CONCLUSIONS
In the existing literature, displaced proximal humerus fractures demonstrate improved Constant scores when treated with joint-preserving options. Age, fracture pattern, and complication rate are significant predictors of the Constant score independent of the selected treatment. Given the observed heterogeneity and variance in treatment techniques in the included studies, more comparative studies are needed to definitively recommend joint-preserving techniques versus arthroplasty for specific fracture patterns.
['Gomberawalla|M Mustafa|MM|', 'Miller|Bruce S|BS|', 'Coale|Robert M|RM|', 'Bedi|Asheesh|A|', 'Gagnier|Joel J|JJ|']
D000368:Aged D000369:Aged, 80 and over D001178:Arthroplasty D005260:Female D005593:Fracture Fixation, Internal D006801:Humans D008297:Male D008875:Middle Aged D018579:Patient Selection D016032:Randomized Controlled Trials as Topic D016059:Range of Motion, Articular D020127:Recovery of Function D012720:Severity of Illness Index D012784:Shoulder Fractures D012785:Shoulder Joint D016896:Treatment Outcome
Meta-analysis Arthroplasty Fractures Proximal humerus Outcomes