Nonoperative Treatment of Proximal Humerus Fractures: A Systematic Review

Iyengar, Jaicharan J.; Devcic, Zlatko; Sproul, R. C.; Feeley, Brian T.

doi:10.1097/bot.0b013e3182008df8

Cited by 118 publications

(76 citation statements)

References 30 publications

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“…Previous studies have demonstrated excellent radiographic healing rates of 98% and low complication rates for PHFs treated with nonoperative measures, 12 lending support to its use as the mainstay of treatment. Further, recent randomized clinical studies have shown comparable outcomes for nonoperative treatment even in displaced surgical neck and comminuted fractures.…”

Section: Discussionmentioning

confidence: 86%

Proximal humerus fragility fractures: recent trends in nonoperative and operative treatment in the Medicare population

Han

Sing

Feeley

et al. 2016

Journal of Shoulder and Elbow Surgery

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Section: Discussionmentioning

confidence: 86%

Proximal humerus fragility fractures: recent trends in nonoperative and operative treatment in the Medicare population

Han

Sing

Feeley

et al. 2016

Journal of Shoulder and Elbow Surgery

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“…24 This is particularly interesting as the PROFHER trial was hailed as a landmark paper by the British Orthopaedic Trainees Association (BOTA). This may lead to a trend to conservative management and may lead to increased rates of fracture sequelae in proximal humerus fractures.…”

Section: Discussionmentioning

confidence: 99%

The role of reverse shoulder arthroplasty in management of proximal humerus fractures with fracture sequelae: a systematic review of the literature

et al. 2017

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Fracture sequelae of the proximal humerus poses a complex management decision due to the frequent deformity and its consequences on the peri-articular soft tissues. These patients are frequently elderly with significant medical comorbidities. Due to the age of the patient there is frequently rotator cuff deficiency and therefore the reverse shoulder arthroplasty (RSA) becomes the arthroplasty of choice. We have performed a systematic review of the literature and report nine studies presenting RSA for the treatment of fracture sequelae of the proximal humerus. It is clear that RSA can improve the range of movement and function following proximal humerus fracture sequelae. However, there is a risk of significant complications including dislocation (16.7%), infection (6.7%), intra-operative fracture (3%) and neurological injury (2.6%). There is a need to invest in future prospective comparative studies and randomised trials to further test RSA in fracture sequelae patients. This will provide us with information regarding the longevity of different prosthesis, outcomes and cost-effectiveness of treatment.

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“…17 However, they acknowledged the inherent biases introduced due to lack of standardized outcomes reporting. 18 A recent meta-analysis has emphasized cautious interpretation of results arguing for equivalence in outcomes for operative versus non-operative fractures. Several important points regarding potential misinterpretations within the existing data include widely variant operative technique and skill, newer technological advents and careful examination of patient characteristics.…”

Section: Discussionmentioning

confidence: 99%

Operative repair of proximal humerus fractures in septuagenarians and octogenarians: Does chronologic age matter?

Goch

Christiano

Konda

et al. 2017

Journal of Clinical Orthopaedics and Trauma

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A B S T R A C TBackground: With an expected doubling of the geriatric population within the next thirty years it is becoming increasingly important to determine who among the elderly population benefit from orthopaedic interventions. This study assesses post-operative outcomes in patients aged seventy or greater who sustained a proximal humerus fracture and were treated surgically as compared to a younger geriatric cohort to determine if there is a chronologic age after which post-operative outcomes significantly decline. Methods: A retrospective chart review was conducted for 201 patients who sustained fractures of the proximal humerus (OTA 11A-C) and were treated operatively by open reduction and internal fixation. Data from 132 independent, active patients aged fifty-five or older was identified and analyzed. Forty-seven patients age 70 or older were compared to 78 patients aged 55-69. Average length of followup was 19.5 months. All complications were recorded. Univariate and multivariate analysis was conducted to assess for differences between groups. Results: 95% of patients achieved fracture union within 6 months. No significant differences were found between cohorts with regard to gender, fracture severity, or CCI (p = 0.197, p = 0.276, p = 0.084, respectively). Functional outcome scores, shoulder range of motion, and complications rates for patients aged 70 and older were not significantly different from patients aged 55-69. There were 10 complications in the older elderly cohort (21%), 6 of which required re-operation and 13 complications in the young elderly cohort (17%), 8 of which required re-operation. Conclusions: Operative fracture repair using locked plating of the proximal humerus in septuagenarians and octogenarians can provide for excellent long-term outcomes in appropriately selected patients. These patients tend to have long term functional outcome scores, post-operative range of motion, and complication rates that are comparable to younger geriatric patients. Physicians should not exclude patients for repair of proximal humerus fractures based on chronological age cutoffs.Published by Elsevier B.V. on behalf of Delhi Orthopedic Association.

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Nonoperative Treatment of Proximal Humerus Fractures: A Systematic Review

Abstract: We conclude that our systematic review of the literature on the nonoperative treatment of proximal humerus fractures demonstrates high rates of radiographic healing, good functional outcomes, and a modest complication rate.

Cited by 118 publications

References 30 publications

Proximal humerus fragility fractures: recent trends in nonoperative and operative treatment in the Medicare population

Proximal humerus fragility fractures: recent trends in nonoperative and operative treatment in the Medicare population

The role of reverse shoulder arthroplasty in management of proximal humerus fractures with fracture sequelae: a systematic review of the literature

Operative repair of proximal humerus fractures in septuagenarians and octogenarians: Does chronologic age matter?

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