OTA2017: NMA of conservative and operative treatments for 3- to 4-part humeral fractures .
Comparison of Surgical and Nonsurgical Treatments for 3 and 4-Part Proximal Humerus Fractures in Patients Over 65 Years: A Network Meta-Analysis
Eight randomized controlled trials were included in this network meta-analysis comparing function, adverse events, and subsequent surgery rates between primary nonoperative treatment, open reduction and internal fixation (ORIF), hemiarthroplasty, and reverse total shoulder arthroplasty (TSA). The only significant difference observed in functional outcome favoured reverse TSA in comparison to hemiarthroplasty. ORIF was associated with significantly higher rates of adverse events and secondary surgery compared to nonoperative treatment, and hemiarthroplasty was associated with a significantly higher rate of adverse events compared to reverse TSA.
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