SynthesisActa orthopaedica2015
Treatment of proximal humerus fractures in the elderly: a systemic review of 409 patients.
Synthesis in Acta orthopaedica, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
34 citing papers in PubMed, 2 syntheses or guidelines pooled it, 73 citations in OpenAlex.
- Interventions for treating proximal humeral fractures in adults.The Cochrane database of systematic reviews · 2022Pooled it
- Pooled it
- Surgery with locking plate or hemiarthroplasty versus nonoperative treatment of 3-4-part proximal humerus fractures in older patients (NITEP): An open-label randomized trial.PLoS medicine · 2023Trial
- Reverse Shoulder Arthroplasty Is Superior to Plate Fixation at 2 Years for Displaced Proximal Humeral Fractures in the Elderly: A Multicenter Randomized Controlled Trial.The Journal of bone and joint surgery. American volume · 2020Trial
- Does the Hertel criteria correlate with postoperative avascular necrosis and failure in proximal humerus fractures? A retrospective cohort study.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026Article
- What is the postoperative prognosis of proximal humeral fractures in China? Protocol for a multicentre prospective cohort study (CAST).BMJ open · 2025Article
- A Study on Functional Outcome of Hemiarthroplasty for Proximal Humeral Fractures - An Observational Study.Journal of orthopaedic case reports · 2025Article
- The Optimal Fibular Strut Bone Graft Fixation Angle for Unstable Proximal Humerus Fractures: A Finite Element Analysis.Bioengineering (Basel, Switzerland) · 2025Article
- The Impact of Frailty Indices on Predicting Complications and Functional Recovery in Proximal Humerus Fractures: A Comparative Study.Medicina (Kaunas, Lithuania) · 2025Article
- Article
- Assessing complications and functional outcomes in proximal humerus fracture management: a retrospective comparison between conservative and intramedullary nailing treatments.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2024Article
- Acute management of fractures in primary care - a cost minimisation analysis.BMC health services research · 2023Article
- Homogeneity in Surgical Series: Image Reporting to Improve Evidence.Journal of clinical medicine · 2023Article
- Article
- Why locking plates for the proximal humerus do not fit well.Archives of orthopaedic and trauma surgery · 2022Article
- Dynamics of balance indicators, activities of daily living, and quality of life of elderly suffering from Parkinson's disease and frailty after proximal humerus fracture following physiotherapeutic functional training.Journal of medicine and life · 2022Article
- Proximal humeral fracture in patients with high Charlson comorbidity index: mortality rate according to treatment choice.Musculoskeletal surgery · 2021Article
- Conversion from a failed proximal femoral nail anti-rotation to a cemented or uncemented total hip arthroplasty device: a retrospective review of 198 hips with previous intertrochanteric femur fractures.BMC musculoskeletal disorders · 2020Review
- Conversion to hemi-shoulder arthroplasty or reverse total shoulder arthroplasty after failed plate osteosynthesis of proximal humerus fractures: a retrospective study.The Journal of international medical research · 2020Article
- Article
Corrections and comments
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Authors and funding
6 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
background and purposeThere is no consensus on the treatment of proximal humerus fractures in the elderly. PATIENTS AND
methodsWe conducted a systematic search of the medical literature for randomized controlled trials and controlled clinical trials from 1946 to Apr 30, 2014. Predefined PICOS criteria were used to search relevant publications. We included randomized controlled trials involving 2- to 4-part proximal humerus fractures in patients over 60 years of age that compared operative treatment to any operative or nonoperative treatment, with a minimum of 20 patients in each group and a minimum follow-up of 1 year. Outcomes had to be assessed with functional or disability measures, or a quality-of-life score.
resultsAfter 2 independent researchers had read 777 abstracts, 9 publications with 409 patients were accepted for the final analysis. No statistically significant differences were found between nonoperative treatment and operative treatment with a locking plate for any disability, for quality-of-life score, or for pain, in patients with 3- or 4-part fractures. In 4-part fractures, 2 trials found similar shoulder function between hemiarthroplasty and nonoperative treatment. 1 trial found slightly better health-related quality of life (higher EQ-5D scores) at 2-year follow-up after hemiarthroplasty. Complications were common in the operative treatment groups (10-29%).
interpretationNonoperative treatment over locking plate systems and tension banding is weakly supported. 2 trials provided weak to moderate evidence that for 4-part fractures, shoulder function is not better with hemiarthroplasty than with nonoperative treatment. 1 of the trials provided limited evidence that health-related quality of life may be better at 2-year follow-up after hemiarthroplasty. There is a high risk of complications after operative treatment.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.