Original articleProximal humeral fractures: A systematic review of treatment modalities
Section snippets
Methods and materials
A literature search of bibliographic databases with limitations of English language and human subjects using key words “proximal humeral fracture” was conducted. The databases utilized were the PubMed database that produced 415 articles, of which 112 were not English, as well as the OVID Embase database. Two independent evaluators analyzed abstracts and titles to identify articles that dealt with the treatment of proximal humeral fractures and met the study inclusion criteria. All articles
Results
The systematic review included a total of 66 publications encompassing 2653 patients who entered the studies and 2155 patients who completed follow-up. The average age of the patients included was 62.8 years, with 70% of these fractures occurring due to a fall from a standing height. The type of fracture with the highest average age was the 2-part fracture group at 69.4 years old, with 83% occurring as a result of a fall from an upright position. The lowest average age was 62.2 years old for
Treatment modality
Nonoperative intervention included sling immobilization for 1-2 weeks followed by physiotherapy,13, 41, 46, 88 swathe immobilization for 30 days followed by physiotherapy,8 or was not clearly defined.86
The ORIF group was further categorized into the subgroups of percutaneous treatment, plating fixation, intramedullary fixation, and miscellaneous fixation. Percutaneous treatment groups did not always specify whether the percutaneous devices were subcutaneous or transcutaneous at the conclusion
Fracture types
While the results of each fracture group is discussed in detail in the following paragraphs, the number of patients in each treatment subset of each fracture type are examined in Appendix II.
Each fracture group was discussed individually to discriminate the unique characteristics of their treatment and outcomes where the outcome measures are comparable (Figure 1, Figure 2, Figure 3, Figure 4, Figure 5). The Neer scores, pain values, subsequent complications, as well as the ROM values, were
Discussion
This study indicates that there is a wide variation in recommended treatments for fractures of the proximal humerus. The quality of the evidence is low and does not support any specific treatment choice. The treatment of a patient with a proximal humeral fracture represents a challenge to the orthopaedic surgeon for a number of reasons. Accurate assessment of fracture type can be difficult, as imaging assessment is imprecise.4, 43, 69, 71, 72 Obtaining and maintaining fracture reduction is
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Supported by Summer Research Training Program, Faculty of Medicine, University of Western Ontario, London, Ontario, Canada, and New Investigator Award, Canadian Institutes of Health Research.