Interventions for treating proximal humeral fractures in adults

摘要: Background Fracture of the proximal humerus, often termed shoulder fracture, is a common injury in older people. The management these fractures varies widely. This an update Cochrane Review first published 2001 and last updated 2012. Objectives To assess effects (benefits harms) treatment rehabilitation interventions for humeral adults. Search methods We searched Bone, Joint Muscle Trauma Group Specialised Register, Central Register Controlled Trials (CENTRAL), MEDLINE, EMBASE, other databases, conference proceedings bibliographies trial reports. full search ended November 2014. Selection criteria We considered all randomised controlled trials (RCTs) quasi-randomised pertinent to adults. Data collection analysis Both review authors performed independent study selection, risk bias assessment data extraction. Only limited meta-analysis was performed. Main results We included 31 heterogeneous RCTs (1941 participants). Most 18 separate comparisons were tested by small single-centre trials. main exception surgical versus non-surgical comparison eight Except large multicentre trial, could not be ruled out. quality evidence either low or very except largest comparison. Nine evaluated mainly minimally displaced fractures. Four compared early (usually one week) delayed (three four weeks) mobilisation after fracture but only pooling possible most from (86 found some that resulted better recovery less pain people with There little difference between two groups complications (2/127 3/132 mobilisation; 4 trials) displacement non-union (2/52 1/54; 2 trials). One (28 participants) Gilchrist-type sling generally more comfortable than Desault-type (body bandage). One (48 testing pulsed electromagnetic high-frequency energy provided no evidence. Two (62 indicating outcome instruction home exercises supervised physiotherapy. reported, without presentable data, exercise alone gave comparable long-term results swimming pool plus exercise. Eight trials, involving 567 participants, intervention high clinically important patient-reported upper-limb function at one- two-year follow-up (primarily locking plate fixation hemiarthroplasty) (sling immobilisation) majority fractures; moderate life years (and interim follow-ups six 12 months). mortality surgery group (17/248 12/248; ratio (RR) 1.40 favouring treatment, 95% confidence interval (CI) 0.69 2.83; P = 0.35; 6 trials); death explicitly linked treatment. higher additional (34/262 16/261; RR 2.06, CI 1.18 3.60; 0.01; 7 trials). Although there adverse events surgery, intervals also potential greater treatment. Different methods (57 comparing types nail treating two-part neck slightly rate surgically-related complications. (61 invasive distally inserted intramedullary K-wires implants years. Compared hemiarthroplasty, (32 similar re-operation rates, whereas another (30 reported five re-operations occurred tension-band group. patient-rated (Quick DASH) composite scores minimum lower incidence reverse arthroplasty (RSA) hemiarthroplasty. No between-group differences (120 deltoid-split approach deltopectoral non-contact bridging fixation, (180 'polyaxial' 'monaxial' screws fixation. (68 produced preliminary tended support use medial (54 fewer events, including re-operations, newer nail. (35 functional hemiarthroplasty. (45 tenodesis long head biceps undergoing hemiarthroplasty. Very suggested outcomes later (one trial: 64 hemiarthroplasty 49 participants). Authors' conclusions There that, does result likely need subsequent surgery. cover tuberosity fractures, young people, trauma, nor such as dislocations splitting fractures. There insufficient inform choices different non-surgical, surgical,