ArticleBone & joint research2016
Trials based on specific fracture configuration and surgical procedures likely to be more relevant for decision making in the management of fractures of the proximal humerus: Findings of a meta-analysis.
Article in Bone & joint research, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 4 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
30 citing papers in PubMed, 4 syntheses or guidelines pooled it, 43 citations in OpenAlex.
- Immediate reverse shoulder arthroplasty demonstrates better outcomes than salvage reverse shoulder arthroplasty for proximal humerus fractures in the elderly: a meta-analysis.Journal of orthopaedic surgery and research · 2026Pooled it
- Interventions for treating proximal humeral fractures in adults.The Cochrane database of systematic reviews · 2022Pooled it
- Complications after non-surgical management of proximal humeral fractures: a systematic review of terms and definitions.BMC musculoskeletal disorders · 2019Pooled it
- Pooled it
- External validity in a multicenter randomized clinical trial of proximal humeral fractures: the DelPhi trial.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2022Trial
- The limited value of routine radiographs in the follow-up treatment of proximal humerus fractures.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026Article
- Gene expression and histological assessment of capsular fibrosis in post-traumatic shoulder stiffness following plate fixation of proximal humeral fractures: an exploratory pilot study.BMC musculoskeletal disorders · 2026Article
- Locking Plate Fixation versus Nonoperative Management in Patients Aged ≥65 Years with Proximal Humerus Fractures: Clinical and Functional Outcomes from a Retrospective Cohort Study.Sisli Etfal Hastanesi tip bulteni · 2026Article
- Non-operative versus reverse shoulder arthroplasty for the treatment of 3- or 4-part proximal humeral fractures: A systematic review and meta-analysis.Journal of clinical orthopaedics and trauma · 2025Review
- Plate osteosynthesis versus non-surgical treatment in displaced proximal humerus fractures-long term functional outcome and quality of life.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2025Article
- Human-centered design of a health recommender system for orthopaedic shoulder treatment.BMC medical informatics and decision making · 2025Article
- Predictive Factors for Poor Prognosis in Non-Surgical Treatment of Proximal Humerus Fractures in Elderly Patients.Cureus · 2024Article
- Intramedullary nailing of proximal humerus fractures does not achieve superior functional results to non-operative treatment in the long term.Archives of orthopaedic and trauma surgery · 2024Article
- Human-centered Design of a Health Recommender System for Orthopaedic Shoulder Treatment.Research square · 2024Article
- Meta-analyses: how can we ensure that the hole is not greater than the sum of the parts?Pediatric nephrology (Berlin, Germany) · 2023Article
- Rising incidence of stair-related upper extremity fractures among older adults in the United States: a 10-year nationwide analysis.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2023Article
- Proximal Humerus Fractures in the Elderly U.S. Population: A Cross-Sectional Study of Treatment Trends and Comparison of Complication Rates after Joint Replacement, Open Reduction and Internal Fixation, and Non-Surgical Management.Journal of clinical medicine · 2023Article
- Proximal humerus fractures - epidemiology, comparison of mortality rates after surgical versus non-surgical treatment, and analysis of risk factors based on Medicare registry data.Bone & joint research · 2023Article
- Assessing the ability of an instrumental variable causal forest algorithm to personalize treatment evidence using observational data: the case of early surgery for shoulder fracture.BMC medical research methodology · 2022Article
- What are the health consequences associated with differences in medical malpractice liability laws? An instrumental variable analysis of surgery effects on health outcomes for proximal humeral facture across states with different liability rules.BMC health services research · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesThe objective of this study was to perform a meta-analysis of all randomised controlled trials (RCTs) comparing surgical and non-surgical management of fractures of the proximal humerus, and to determine whether further analyses based on complexity of fracture, or the type of surgical intervention, produced disparate findings on patient outcomes.
methodsA systematic review of the literature was performed identifying all RCTs that compared surgical and non-surgical management of fractures of the proximal humerus. Meta-analysis of clinical outcomes was performed where possible. Subgroup analysis based on the type of fracture, and a sensitivity analysis based on the type of surgical intervention, were also performed.
resultsSeven studies including 528 patients were included. The overall meta-analysis found that there was no difference in clinical outcomes. However, subgroup and sensitivity analyses found improved patient outcomes for more complex fractures managed surgically. Four-part fractures that underwent surgery had improved long-term health utility scores (mean difference, MD 95% CI 0.04 to 0.28; p = 0.007). They were also less likely to result in osteoarthritis, osteonecrosis and non/malunion (OR 7.38, 95% CI 1.97 to 27.60; p = 0.003). Another significant subgroup finding was that secondary surgery was more common for patients that underwent internal fixation compared with conservative management within the studies with predominantly three-part fractures (OR 0.15, 95% CI 0.04 to 0.63; p = 0.009).
conclusionThis meta-analysis has demonstrated that differences in the type of fracture and surgical treatment result in outcomes that are distinct from those generated from analysis of all types of fracture and surgical treatments grouped together. This has important implications for clinical decision making and should highlight the need for future trials to adopt more specific inclusion criteria.Cite this article: S. Sabharwal, N. K. Patel, D. Griffiths, T. Athanasiou, C. M. Gupte, P. Reilly. Trials based on specific fracture configuration and surgical procedures likely to be more relevant for decision making in the management of fractures of the proximal humerus: Findings of a meta-analysisBone Joint Res 2016;5:470-480. DOI: 10.1302/2046-3758.510.2000638.
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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.