Nonsurgical treatment is recommended for proximal humeral fractures in elderly patients .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2014;2(1):32 PLoS One. 2013 Sep 16;8(9):e75464Three randomized control trials with a total of 130 patients were pooled in this meta-analysis to compare non-operative treatment methods versus open reduction and internal fixation for proximal humerus fractures in the elderly. No differences were found in Constant Scores, nonunion rate, risk of avascular necrosis of the humeral head or osteoarthritis. The results of this study do not encourage the surgical treatment for older patients with fractures of the proximal humerus.
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نعم = 1
غير مؤكد = 0.5
غير ذي صلة = 0
لا = 0
يقيّم تقييم معايير الإبلاغ الشفافية التي يبلغ بها المؤلفون عن الخصائص المنهجية والتجريبية للتجربة في المنشور. ينقسم التقييم إلى خمس فئات معروضة أدناه.
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Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
مؤشر الهشاشة هو أداة تساعد في تفسير النتائج المهمة، وتوفر مقياسًا لقوة النتيجة. ويمثل مؤشر الهشاشة عدد الأحداث المتتالية التي يجب إضافتها إلى نتيجة ثنائية التفرع لجعل النتيجة غير مهمة. يمثل الرقم الصغير نتيجة أضعف ويمثل الرقم الكبير نتيجة أقوى.
لماذا كانت هناك حاجة لهذه الدراسة الآن؟
Six percent of all fractures treated in the emergency department are proximal humeral fractures and the majority can be successfully treated without surgery. These fractures are the most common type of fracture occurring in elderly patients and 13 to 16% are comminuted, displaced and categorized as 3- and 4-part fractures according to the Neer Classification. Controversy lies in the whether comminuted displaced fractures in elderly patients with osteoporosis who experienced low energy trauma should be treated with surgery or not. A select number of randomized control studies compare open reduction and internal fixation to conservative methods and this meta-analysis was brought forward to pool the data from the trials available to re-evaluate the use of both treatments.
ما هو سؤال البحث الرئيسي؟
Are comminuted displaced humeral fractures in elderly patients best treated with open reduction and internal fixation or non-operative treatments?
- All three studies (n=130) examined Constant score and the outcomes were similar between surgical and nonsurgical treatment groups (WMD 20.51, 95% CI: 27.25 to 6.22, P= 0.88, I squared = 0%).
- The 3 studies found nonunion was uncommon in both groups and that the difference between the two was insignificant (RR =0.78; 95% CI: 0.18–3.41, P= 0.74, I squared = 0%).
- In the 3 RCT's examined, no difference was found in the risk of avascular necrosis of humeral head (RR = 0.86; 95% CI: 0.46–1.58, P= 0.62, I squared =0%).
- 2 of the studies (82 patients) reported data on osteoarthritis and neither treatment arm provided additional benefits (RR = 1.34; 95% CI: 0.37–4.82, P= 0.66, I squared =0%).
ما الذي يجب أن أتذكره أكثر؟
No benefits were found regarding constant score, nonunion rate, risk of avascular necrosis of the humeral head or osteoarthritis with open reduction and internal fixation over nonsurgical methods. Both nonunion rates and risk of avascular necrosis were low in each group.
كيف سيؤثر ذلك على رعاية مرضاي؟
This meta-analysis of 3 randomized control studies suggests non-operative treatment should be used for 3- and 4-part proximal humeral fractures in elderly patients over open reduction and internal fixation, as there is no additional benefit of the operative treatment. This study was limited by the modest quantity of studies and few clinical outcomes observed.
تنويه
هذا المحتوى الموجود في هذه الصفحة هو لأغراض إعلامية فقط وليس الغرض منه أن يكون بديلاً عن المشورة الطبية المتخصصة أو التشخيص أو العلاج. إذا كنت بحاجة إلى علاج طبي، اطلب دائمًا مشورة طبيبك أو اذهب إلى أقرب قسم طوارئ إليك. الآراء والمعتقدات ووجهات النظر التي يعبر عنها الأفراد في المحتوى الموجود في هذه الصفحة لا تعكس آراء ومعتقدات ووجهات نظر أورثوإيفيدنس.
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