Similar clinical results seen for conservative care vs. surgery of humerus fractures
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Although a study in the Journal of Shoulder and Elbow Surgery found comparable clinical and range of motion results for conservative vs. surgical treatment of displaced proximal humerus fractures, surgery had a higher rate of complications.
Researchers wrote that the study conclusion should be interpreted with caution due to the high risk of bias and low level of certainty of the studies used in the analysis.
Erik Hohmann, MBBS, FRCS, FRCS (Tr & Orth), MD, PhD, and colleagues used Medline, Embase, Scopus and Google Scholar databases to perform a systematic review and meta-analysis of 22 studies that compared conservative treatment with surgical treatment of displaced proximal humerus fractures. Among the studies, there were 817 cases of nonoperative management and 997 cases of surgery.
Outcomes measure included Constant and American Shoulder and Elbow Surgeons scores, range of motion (ROM) and complications. Researchers also analyzed risk of bias and quality of the body of evidence among the studies.
Overall, Hohmann and colleagues found the differences in clinical and ROM outcomes between the cohorts were negligible. Researchers noted surgical treatment yielded slightly better improvements in abduction, forward flexion and external rotation; however, these differences were not statistically significant. Researchers found complication rates were 3.3 times higher in the surgery cohort compared with the nonoperative cohort.
Hohmann and colleagues noted the high risk of bias and low quality of evidence among the studies.
“The validity of this result is compromised by the high risk of bias and very low level of certainty of the included studies, and the conclusion must therefore be interpreted with caution,” the researchers wrote in the study.
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