Primary shoulder arthroplasty versus conservative treatment for comminuted proximal humeral fractures: a systematic literature review

Dennis den Hartog, Jeroen de Haan, Niels W Schep, Wim E Tuinebreijer, Dennis den Hartog, Jeroen de Haan, Niels W Schep, Wim E Tuinebreijer

Abstract

The objective was to identify whether arthroplasty or conservative treatment is the best available treatment for three- and four-part proximal humeral fractures by analyzing the outcome measure of the Constant score. We conducted an electronic search. The systematic review included 33 studies encompassing 1096 patients with three- or four-part proximal humeral fractures that used the Constant score as outcome measure. The mean Constant score in the conservative group was 66.5 and in the arthroplasty group was 55.5. The difference could be attributed to selection bias, unreliable classification of the fractures and inter-observer differences in the assessment of the Constant score.

Keywords: Proximal humeral fractures; arthroplasty; review; shoulder fractures; therapy..

Figures

Fig. (1)
Fig. (1)
Funnel plot of Constant scores by sample size of the arthroplasty group in 30 patient groups (mean Constant score = 55.5) and of the conservative group in 11 patient groups (mean Constant score = 66.5).
Fig. (2)
Fig. (2)
Funnel plot of Constant scores by year of publication of the arthroplasty group in 30 patient groups (mean Constant score = 55.5) and of the conservative group in 11 patient groups (mean Constant score = 66.5).

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