Interventions for Treating 3- or 4-part proximal humeral fractures in elderly patient: A network meta-analysis of randomized controlled trials

• Published in: International journal of surgery (London, England) Vol. 48; pp. 240 - 246
• Main Authors: Du, Shaolong, Ye, Jiahao, Chen, Haolong, Li, Xishan, Lin, Qiang
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.12.2017
• Subjects: Elderly patient; Network meta-analysis; Nonoperation; ORIF; Proximal humeral fractures; RSA; RSA; Elderly patient; Network meta-analysis; ORIF; Nonoperation; HA; Proximal humeral fractures
• ISSN: 1743-9191; 1743-9159
• DOI: 10.1016/j.ijsu.2017.09.002

The fractures of proximal humerus have a high incidence in elderly patients, especially 3- or 4-part fracture. There are 4 main treatments including nonoperation, open reduction and internal fixation(ORIF), hemiarthroplasty(HA) and reverse shoulder arthroplasty(RSA). However, which one is the optimal choice remains a controversial topic. Through the search of three electronic databases (PubMed, Embase, and Cochrane), the randomized controlled trials of 3- or 4-part proximal humeral fracture, until the end of July 2017, which is concerned with the elderly patients, were identified. The quality evaluation of each study was evaluated, Constant score and reoperation rates were extracted and analyzed. We used R(R i386 3.3.2) and the package of gemtc to perform our network meta-analysis. Seven randomized controlled experiments with a total number of 347 patients were brought into our network meta-analysis. The rank probability plot of Constant score showed that the RSA had significantly the highest Constant score and lower reoperation than other treatments. The other way around, the efficacy of ORIF was the poorest. The rank for the Constant score was: RSA, HA, nonoperation and ORIF. The rank for the reduction in total reoperation rates was: RSA, nonoperation, HA and ORIF. The statistical result suggested that RSA has become a beneficial choice to treat displaced 3-or 4-part fracture in elderly patients, that might result in more favorable clinical outcomes and reduction of reoperation rates than other methods performed for the same indication. But the ORIF is the worst. •This is the first network meta-analysis assessed the treatments of 3- or 4-part fracture of proximal humeral fracture in geriatric patient.•This study overcomed the constraint of conventional meta-analysis to distinguish the subtle differences among 4 treatments.•This was done by combining the efficacy of treatment strategies through combine the direct and indirect result.•Statistical result suggested RSA has become beneficial choice to treat displaced 3- and 4-part fractures in elderly patient.•Might result in more favorable clinical outcomes and reduction of reoperation rates than other methods for same indication.