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Intervention Review

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Interventions for treating proximal humeral fractures in adults

  1. Helen HG Handoll1,*,
  2. Benjamin J Ollivere2,
  3. Katie E Rollins3

Editorial Group: Cochrane Bone, Joint and Muscle Trauma Group

Published Online: 12 DEC 2012

Assessed as up-to-date: 18 APR 2012

DOI: 10.1002/14651858.CD000434.pub3


How to Cite

Handoll HHG, Ollivere BJ, Rollins KE. Interventions for treating proximal humeral fractures in adults. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD000434. DOI: 10.1002/14651858.CD000434.pub3.

Author Information

  1. 1

    Teesside University, Health and Social Care Institute, Middlesbrough, Tees Valley, UK

  2. 2

    Queen's Medical Centre, Department of Trauma and Orthopaedics, Nottingham, UK

  3. 3

    Cambridge University Hospital NHS Foundation Trust, Department of General Surgery, Cambridge, Cambridgeshire, UK

*Helen HG Handoll, Health and Social Care Institute, Teesside University, Middlesbrough, Tees Valley, TS1 3BA, UK. h.handoll@tees.ac.uk. H.Handoll@ed.ac.uk.

Publication History

  1. Publication Status: New search for studies and content updated (conclusions changed)
  2. Published Online: 12 DEC 2012

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This is not the most recent version of the article. View current version (11 NOV 2015)

[Figure 1]
Figure 1. Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
[Figure 2]
Figure 2. Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
[Analysis 1.1]
Analysis 1.1. Comparison 1 Early mobilisation (within or up to 1 week) versus immobilisation for 3 weeks, Outcome 1 Shoulder disability: Croft Shoulder Disability Score.
[Analysis 1.2]
Analysis 1.2. Comparison 1 Early mobilisation (within or up to 1 week) versus immobilisation for 3 weeks, Outcome 2 Croft shoulder disability score: individual problems at 2 years.
[Analysis 1.3]
Analysis 1.3. Comparison 1 Early mobilisation (within or up to 1 week) versus immobilisation for 3 weeks, Outcome 3 Number of treatment sessions (until independent function achieved).
[Analysis 1.4]
Analysis 1.4. Comparison 1 Early mobilisation (within or up to 1 week) versus immobilisation for 3 weeks, Outcome 4 SF-36 scores: pain & physical dimensions.
[Analysis 1.5]
Analysis 1.5. Comparison 1 Early mobilisation (within or up to 1 week) versus immobilisation for 3 weeks, Outcome 5 Adverse events.
[Analysis 1.6]
Analysis 1.6. Comparison 1 Early mobilisation (within or up to 1 week) versus immobilisation for 3 weeks, Outcome 6 Constant shoulder score (ratio of affected/unaffected arm).
[Analysis 1.7]
Analysis 1.7. Comparison 1 Early mobilisation (within or up to 1 week) versus immobilisation for 3 weeks, Outcome 7 Constant shoulder score (0 to 100: best).
[Analysis 1.8]
Analysis 1.8. Comparison 1 Early mobilisation (within or up to 1 week) versus immobilisation for 3 weeks, Outcome 8 Changes in pain intensity (mm) from baseline: 100 mm visual analogue scale (positive change = less pain).
[Analysis 1.9]
Analysis 1.9. Comparison 1 Early mobilisation (within or up to 1 week) versus immobilisation for 3 weeks, Outcome 9 Range of motion at 6 months (degrees): difference between two shoulders.
[Analysis 1.10]
Analysis 1.10. Comparison 1 Early mobilisation (within or up to 1 week) versus immobilisation for 3 weeks, Outcome 10 Patient dissatisfied with treatment.
[Analysis 2.1]
Analysis 2.1. Comparison 2 Gilchrist bandage versus 'Classic' Desault bandage, Outcome 1 Problems with bandages.
[Analysis 2.2]
Analysis 2.2. Comparison 2 Gilchrist bandage versus 'Classic' Desault bandage, Outcome 2 Fracture displacement by 3 weeks.
[Analysis 2.3]
Analysis 2.3. Comparison 2 Gilchrist bandage versus 'Classic' Desault bandage, Outcome 3 Poor or bad rating by patient at fracture consolidation.
[Analysis 3.1]
Analysis 3.1. Comparison 3 Instructed self physiotherapy versus conventional physiotherapy, Outcome 1 Pain at one year (scale 0 to 8: maximum pain).
[Analysis 3.2]
Analysis 3.2. Comparison 3 Instructed self physiotherapy versus conventional physiotherapy, Outcome 2 Severe or moderate pain at 3 months.
[Analysis 3.3]
Analysis 3.3. Comparison 3 Instructed self physiotherapy versus conventional physiotherapy, Outcome 3 Requested change of therapy.
[Analysis 3.4]
Analysis 3.4. Comparison 3 Instructed self physiotherapy versus conventional physiotherapy, Outcome 4 Adverse events (frozen shoulder: 1 v 2; unexplained prolonged pain: 0 v 1).
[Analysis 3.5]
Analysis 3.5. Comparison 3 Instructed self physiotherapy versus conventional physiotherapy, Outcome 5 Neer's rating (0 to 100: best) at mean 16 months (exploratory analysis).
[Analysis 3.6]
Analysis 3.6. Comparison 3 Instructed self physiotherapy versus conventional physiotherapy, Outcome 6 Active gleno-humeral elevation (degrees).
[Analysis 4.1]
Analysis 4.1. Comparison 4 Surgery versus conservative treatment, Outcome 1 Functional scores at 12 months (higher = worse).
[Analysis 4.2]
Analysis 4.2. Comparison 4 Surgery versus conservative treatment, Outcome 2 DASH (0 to 100: worst disability).
[Analysis 4.3]
Analysis 4.3. Comparison 4 Surgery versus conservative treatment, Outcome 3 American Shoulder and Elbow Surgeons score (0 to 24: best).
[Analysis 4.4]
Analysis 4.4. Comparison 4 Surgery versus conservative treatment, Outcome 4 Activities of daily living.
[Analysis 4.5]
Analysis 4.5. Comparison 4 Surgery versus conservative treatment, Outcome 5 Quality of life assessment: EuroQol (0: dead to 1: best health).
[Analysis 4.6]
Analysis 4.6. Comparison 4 Surgery versus conservative treatment, Outcome 6 Quality of life assessment (Fjalestad 2010 data).
[Analysis 4.7]
Analysis 4.7. Comparison 4 Surgery versus conservative treatment, Outcome 7 Mortality.
[Analysis 4.8]
Analysis 4.8. Comparison 4 Surgery versus conservative treatment, Outcome 8 Additional surgery (re-operation or secondary surgery).
[Analysis 4.9]
Analysis 4.9. Comparison 4 Surgery versus conservative treatment, Outcome 9 Adverse events / complications.
[Analysis 4.10]
Analysis 4.10. Comparison 4 Surgery versus conservative treatment, Outcome 10 Constant scores (overall: 0 to 100: best score).
[Analysis 4.11]
Analysis 4.11. Comparison 4 Surgery versus conservative treatment, Outcome 11 Constant scores (difference between injured and uninjured shoulder): Normal = 0..
[Analysis 4.12]
Analysis 4.12. Comparison 4 Surgery versus conservative treatment, Outcome 12 Poor or unsatisfactory function at 1 year (Neer rating).
[Analysis 4.13]
Analysis 4.13. Comparison 4 Surgery versus conservative treatment, Outcome 13 Dependent in activities of daily living (or dead) at 6 months.
[Analysis 4.14]
Analysis 4.14. Comparison 4 Surgery versus conservative treatment, Outcome 14 Pain at 2 years: VAS (0 to 100: worst pain).
[Analysis 4.15]
Analysis 4.15. Comparison 4 Surgery versus conservative treatment, Outcome 15 Constant score at 50 months: overall and components.
[Analysis 4.16]
Analysis 4.16. Comparison 4 Surgery versus conservative treatment, Outcome 16 Constant (often severe) pain at 6 months.
[Analysis 4.17]
Analysis 4.17. Comparison 4 Surgery versus conservative treatment, Outcome 17 Failure to recover 75% muscle power relative to other arm (survivors) at 6 months.
[Analysis 4.18]
Analysis 4.18. Comparison 4 Surgery versus conservative treatment, Outcome 18 Range of movement impairments in survivors at 6 months.
[Analysis 4.19]
Analysis 4.19. Comparison 4 Surgery versus conservative treatment, Outcome 19 Costs at 1 year (Euros in 2005).
[Analysis 4.20]
Analysis 4.20. Comparison 4 Surgery versus conservative treatment, Outcome 20 Total costs including indirect costs (Euros) at 1 year.
[Analysis 5.1]
Analysis 5.1. Comparison 5 Locking plate versus locking intramedullary nail, Outcome 1 American Shoulder and Elbow Surgeons (ASES) score (0 to 100: best).
[Analysis 5.2]
Analysis 5.2. Comparison 5 Locking plate versus locking intramedullary nail, Outcome 2 Death, re-operation and adverse events.
[Analysis 5.3]
Analysis 5.3. Comparison 5 Locking plate versus locking intramedullary nail, Outcome 3 Pain (VAS: 0 to 10: worst).
[Analysis 5.4]
Analysis 5.4. Comparison 5 Locking plate versus locking intramedullary nail, Outcome 4 Constant score (0 to 100: best).
[Analysis 5.5]
Analysis 5.5. Comparison 5 Locking plate versus locking intramedullary nail, Outcome 5 Active range of motion (at 3 years).
[Analysis 5.6]
Analysis 5.6. Comparison 5 Locking plate versus locking intramedullary nail, Outcome 6 Range of movement: internal rotation (level on spine).
[Analysis 5.7]
Analysis 5.7. Comparison 5 Locking plate versus locking intramedullary nail, Outcome 7 Strength of suprapinatus (relative to opposite side) % - at 3 years.
[Analysis 5.8]
Analysis 5.8. Comparison 5 Locking plate versus locking intramedullary nail, Outcome 8 Operation times and blood loss.
[Analysis 5.9]
Analysis 5.9. Comparison 5 Locking plate versus locking intramedullary nail, Outcome 9 Intra-operative complication.
[Analysis 6.1]
Analysis 6.1. Comparison 6 Locking plate versus intramedullary nails (Zifko method), Outcome 1 Complications and [slight] malunion.
[Analysis 6.2]
Analysis 6.2. Comparison 6 Locking plate versus intramedullary nails (Zifko method), Outcome 2 Constant score (% of healthy limb) at mean 2 years.
[Analysis 6.3]
Analysis 6.3. Comparison 6 Locking plate versus intramedullary nails (Zifko method), Outcome 3 Time to union and time to recover upper limb function (weeks).
[Analysis 6.4]
Analysis 6.4. Comparison 6 Locking plate versus intramedullary nails (Zifko method), Outcome 4 Operation and fluoroscopic times.
[Analysis 6.5]
Analysis 6.5. Comparison 6 Locking plate versus intramedullary nails (Zifko method), Outcome 5 Length of hospital stay (days).
[Analysis 7.1]
Analysis 7.1. Comparison 7 Hemi-arthroplasty versus tension band wiring (4 part fractures), Outcome 1 Re-operation at 1 year.
[Analysis 7.2]
Analysis 7.2. Comparison 7 Hemi-arthroplasty versus tension band wiring (4 part fractures), Outcome 2 Implant removal at 1 year.
[Analysis 7.3]
Analysis 7.3. Comparison 7 Hemi-arthroplasty versus tension band wiring (4 part fractures), Outcome 3 Pain at 1 year.
[Analysis 8.1]
Analysis 8.1. Comparison 8 Polyaxial versus monoaxial screw insertion in plate fixation, Outcome 1 DASH score at 12 months (0 to 100: greatest disability).
[Analysis 8.2]
Analysis 8.2. Comparison 8 Polyaxial versus monoaxial screw insertion in plate fixation, Outcome 2 Simple shoulder test (0 to 12: best outcome).
[Analysis 8.3]
Analysis 8.3. Comparison 8 Polyaxial versus monoaxial screw insertion in plate fixation, Outcome 3 Re-operation.
[Analysis 8.4]
Analysis 8.4. Comparison 8 Polyaxial versus monoaxial screw insertion in plate fixation, Outcome 4 Dead at 1 year.
[Analysis 8.5]
Analysis 8.5. Comparison 8 Polyaxial versus monoaxial screw insertion in plate fixation, Outcome 5 Constant score at 12 months (% of contralateral limb).
[Analysis 8.6]
Analysis 8.6. Comparison 8 Polyaxial versus monoaxial screw insertion in plate fixation, Outcome 6 Complications (radiological assessment).
[Analysis 8.7]
Analysis 8.7. Comparison 8 Polyaxial versus monoaxial screw insertion in plate fixation, Outcome 7 Range of motion (degrees) at 12 months.
[Analysis 8.8]
Analysis 8.8. Comparison 8 Polyaxial versus monoaxial screw insertion in plate fixation, Outcome 8 Operation and fluoroscopic times.
[Analysis 9.1]
Analysis 9.1. Comparison 9 Medial support screws versus control for locking plate fixation, Outcome 1 Adverse events.
[Analysis 9.2]
Analysis 9.2. Comparison 9 Medial support screws versus control for locking plate fixation, Outcome 2 Constant score (0 to 100: best) at 2.5 years.
[Analysis 10.1]
Analysis 10.1. Comparison 10 Hemiarthoplasty: EPOCA prosthesis versus HAS prosthesis, Outcome 1 Adverse events.
[Analysis 10.2]
Analysis 10.2. Comparison 10 Hemiarthoplasty: EPOCA prosthesis versus HAS prosthesis, Outcome 2 Radiological assessment findings.
[Analysis 10.3]
Analysis 10.3. Comparison 10 Hemiarthoplasty: EPOCA prosthesis versus HAS prosthesis, Outcome 3 Range of motion results at one year (degrees).
[Analysis 11.1]
Analysis 11.1. Comparison 11 Post-operative (percutaneous fixation) immobilisation for 1 week versus 3 weeks, Outcome 1 Neer score ≤ 80 points (unsatisfactory or failure) at 6 months.
[Analysis 11.2]
Analysis 11.2. Comparison 11 Post-operative (percutaneous fixation) immobilisation for 1 week versus 3 weeks, Outcome 2 Premature removal of Kirschner wires.
[Analysis 12.1]
Analysis 12.1. Comparison 12 Post-operative (hemiarthroplasty) mobilisation: early (2 weeks immobilisation) versus late (6 weeks), Outcome 1 Oxford Shoulder Score at 1 year (adjusted: 0 to 100 best).
[Analysis 12.2]
Analysis 12.2. Comparison 12 Post-operative (hemiarthroplasty) mobilisation: early (2 weeks immobilisation) versus late (6 weeks), Outcome 2 Constant shoulder score (at 1 year).
[Analysis 12.3]
Analysis 12.3. Comparison 12 Post-operative (hemiarthroplasty) mobilisation: early (2 weeks immobilisation) versus late (6 weeks), Outcome 3 Radiological assessment findings.
[Analysis 12.4]
Analysis 12.4. Comparison 12 Post-operative (hemiarthroplasty) mobilisation: early (2 weeks immobilisation) versus late (6 weeks), Outcome 4 Range of motion at 1 year.