A Cochrane review [Abstract] 1 included 31 heterogeneous studies with a total of 1941 subjects. Most of the 18 separate treatment comparisons were tested by small single-centre trials. There was no difference in surgical (mainly open reduction and internal fixation with locking plate or hemiarthroplasty) versus non-surgical treatment (mainly sling 'immobilisation'; more rarely, closed reduction/manipulation of the fracture) for proximal humeral fractures in 8 trials with 567 older participants (table T1).
| Outcome | Relative effect(95% CI) | Assumed risk - Non-surgical treatment | Corresponding risk - Surgical treatment | No of Participants(studies) |
|---|---|---|---|---|
| Functional scores at 1 year (higher = better outcome: 0.2 represents a small difference, 0.5 a moderate difference and 0.8 a large difference) | SMD 0.07(-0.12 to 0.26) | Mean difference 0.07 (-0.12 to 0.26) | 419 (5) | |
| Functional scores at 2 years | SMD 0.07 (-0.14 to 0.28) | Mean difference 0.07 (-0.14 to 0.28) | 351 (4) | |
| Quality of life assessment: EuroQol (0: dead to 1: best health) at 2 years | Mean EuroQol score 0.7 to 0.85 | Mean EuroQol score 0.03 higher,(-0.01 to 0.08) | 354 (4) | |
| Additional surgery (re-operation or secondary surgery)up to 2 years | RR 2.06(1.18 to 3.60) | 40/1000 | 83 /1000(47 to 144) | 523 (7) |
Nine trials evaluated non-surgical treatment in mainly minimally displaced fractures. Four trials compared early (usually one week) versus delayed (3 or 4 weeks) mobilisation after fracture but only limited pooling was possible and most of the data were from one trial (86 participants). This found some evidence that early mobilisation resulted in better recovery and less pain in people with mainly minimally displaced fractures. There was evidence of little difference between the two groups in shoulder complications (2/127 early mobilisation versus 3/132 delayed mobilisation; 4 trials) and fracture displacement and non-union (2/52 versus 1/54; 2 trials).
Comment: The quality of evidence is downgraded by imprecise results (few patients).
Primary/Secondary Keywords