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In older people with breaks of the upper arm at the shoulder, surgical treatments do not improve functioning more than nonsurgical treatments

Launonen AP, Lepola V, Flinkkila T, et al. Treatment of proximal humerus fractures in the elderly. Acta Orthop. 2015;86:280-5.

Review question

In older people with breaks of the upper arm (the humerus) at the shoulder, do surgical treatments improve functioning compared with other treatments?

Background

Breaks of the upper humerus are common in older people. The severity of a fracture of the upper arm is determined by the number of parts of the bone that are broken and whether the ends of the bone line up or are displaced.

There are several ways to treat breaks of the humerus. Nonsurgical treatments include immobilization and exercise. Surgical treatments include use of pins, locking plates (screws fused with plates), tension bands, or partial replacement of the shoulder with reconstruction (hemiarthroplasty). There is little evidence for which approach works best for treating upper arm breaks.

How the review was done

The researchers did a systematic review based on studies available up to April 2014.

They found 9 studies, including 8 randomized controlled trials and 1 controlled clinical trial, with 409 people. The average age ranged from 72 to 81 years.

Key features of the studies were:

  • people were 60 years of age or older;
  • people had breaks of the humerus at the shoulder: the breaks involved 3 or 4 parts of the bone and at least 2 parts were not properly lined up;
  • the treatments included use of tension bands, pinning, plating, and shoulder replacement with reconstruction;
  • the treatments were compared with nonsurgical treatments and other surgical treatments; and
  • the results were assessed 1 or 2 years after treatment.

What the researchers found

Compared with nonsurgical treatment:

  • treatment with a tension band or locking plate did not improve pain or functioning 1 year after treatment; and
  • shoulder replacement with reconstruction improved quality of life, but not pain and functioning or disability, 2 years after treatment.

Complications were common in the surgical treatment groups (10% to 29%).

Additional details appear in the Table below.

Conclusion

In older people with breaks of the upper arm at the shoulder, surgical treatments do not improve functioning more than nonsurgical treatments.

Surgical treatments in older people with breaks of the upper arm

Surgical treatment

Comparator

Findings

Tension band

Nonsurgical treatment

1 study (40 people) found no improvement in pain and functioning at 1 year with the tension band.

Locking plate

Nonsurgical treatment

1 study (50 people) found no improvement in pain and functioning or quality of life at 1 year with the locking plate.

1 study (60 people) found no improvement in pain and functioning, disability, or quality of life at 2 years with the locking plate.

Shoulder replacement with reconstruction

Nonsurgical treatment

1 study (50 people) found no improvement in pain and functioning or pain alone at 1 year.

1 study (55 people) found improvement in quality of life, but not disability or pain and functioning, at 2 years with shoulder replacement.

 




Glossary

Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

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