ArticleShoulder & elbow2020
Comparison of surgical and non-surgical treatments for 3- and 4-part proximal humerus fractures: A network meta-analysis.
Article in Shoulder & elbow, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04623346 (Orthopaedic Conservative Treatment in the Time of Covid-19 Pandemic), which is not on this map. Cited by 15 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.
Orthopaedic Conservative Treatment in the Time of Covid-19 Pandemic
Who cites it
15 citing papers in PubMed, 2 syntheses or guidelines pooled it, 40 citations in OpenAlex.
- Interventions for treating proximal humeral fractures in adults.The Cochrane database of systematic reviews · 2022Pooled it
- Comparison between minimally invasive plate osteosynthesis and open reduction-internal fixation for proximal humeral fractures: a meta-analysis based on 1050 individuals.BMC musculoskeletal disorders · 2019Pooled it
- 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
- Delphi method consensus on radiographic characteristics influencing management decisions for proximal humerus fracture.Journal of orthopaedic surgery and research · 2025Article
- Trends in Shoulder Arthroplasty: A Narrative Review of Predominant Indications and the Most Commonly Employed Implant Designs.Journal of clinical medicine · 2025Review
- Proximal humerus fractures: Treatment controversies.OTA international : the open access journal of orthopaedic trauma · 2025Article
- Reverse Shoulder Arthroplasty versus Non-Operative Treatment of Three-Part and Four-Part Proximal Humerus Fractures in the Elderly Patient: A Pooled Analysis and Systematic Review.Journal of clinical medicine · 2024Review
- Treatment of 2-part, 3-part, and 4-part proximal humerus fractures from 2016 to 2020: A nationally-representative database.Journal of orthopaedics · 2024Article
- Transitivity, coherence, and reliability of network meta-analyses comparing proximal humerus fracture treatments: a meta-epidemiological study.BMC musculoskeletal disorders · 2024Article
- Contralateral preoperative templating for fracture reverse total shoulder arthroplasty: technique article and case series.JSES reviews, reports, and techniques · 2023Article
- Impact of Age on Functional Outcome After Reverse Shoulder Arthroplasty Performed for Proximal Humerus Fractures or Their Sequelae.The archives of bone and joint surgery · 2023Article
- Management of Proximal Humerus Fractures in Adults-A Scoping Review.Journal of clinical medicine · 2022Article
- Outcomes for type C proximal humerus fractures in the adult population: comparison of nonoperative treatment, locked plate fixation, and reverse shoulder arthroplasty.JSES international · 2022Article
- Correlation and responsiveness of global health, upper extremity-specific, and shoulder-specific functional outcome measures following reverse total shoulder arthroplasty for proximal humerus fracture.BMC musculoskeletal disorders · 2021Article
- Position statement: management of proximal humerus fractures.Canadian journal of surgery. Journal canadien de chirurgieReview
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionCommon treatment strategies for proximal humerus fractures include non-surgical treatment, open reduction internal fixation, hemiarthroplasty, and reverse total shoulder arthroplasty. There is currently no consensus regarding the superiority of any one surgical strategy. We used network meta-analysis of randomized controlled trials to determine the most successful treatment for proximal humerus fractures.
methodsMEDLINE, EMBASE, Web of Science, and Cochrane Central electronic databases were searched for randomized controlled trials comparing 3- and 4-part proximal humerus fracture treatments. Data extraction included the mean and standard deviation of clinical outcomes (Constant, DASH), adverse events, and additional surgery rates. Standard Mean Difference was used to compare clinical outcome scores, and pooled risk ratios were used to compare adverse events and additional surgeries.
resultsEight randomized controlled trials were included for network meta-analysis. Non-surgical treatment was associated with a lower rate of additional surgery and adverse events compared to open reduction internal fixation. Reverse total shoulder arthroplasty resulted in fewer adverse events and a better clinical outcome score than hemiarthroplasty. Non-surgical treatment produced similar clinical scores, adverse event rates, and additional surgery rates to hemiarthroplasty and reverse total shoulder arthroplasty.
conclusionNon-surgical treatment results in fewer complications and additional surgeries compared to open reduction internal fixation. Preliminary data supports reverse total shoulder arthroplasty over hemiarthroplasty, but more evidence is needed to strengthen this conclusion.
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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.