Evidence map›Paper›PMID 39775965›Full record

SynthesisEuropean journal of orthopaedic surgery & traumatology : orthopedie traumatologie2025

Is surgical treatment better than non-surgical treatment for proximal humeral fracture in elderly people? A meta-analysis and meta-regression.

Paulo Roberto Hernandes Júnior, Thiago Alves Garcia, Renato de Oliveira Caravellos Glória, Gustavo Waldolato, André Luis Lugnani de Andrade, Pedro José Labronici, William Dias Belangero

Abstract readMeta-AnalysisSystematic Review
PubMed Publisher
In one paragraph

Synthesis in European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Long-term functional outcomes of Aequalis fracture hemiarthroplasty for proximal humerus fracture: a retrospective case series.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2025
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Paulo Roberto Hernandes JúniorUniversity of Vassouras, Vassouras, Brazil. paulorh.eng@gmail.com.
Thiago Alves GarciaState University of Campinas, Campinas, Brazil.
Renato de Oliveira Caravellos GlóriaFluminense Federal University, Niterói, Brazil.
Gustavo WaldolatoFaculty of Medical Sciences of Minas Gerais, Belo Horizonte, Brazil.
André Luis Lugnani de AndradeMedical Science Faculty of the State University of Campinas, Campinas, Brazil.
Pedro José LabroniciFluminense Federal University, Niterói, Brazil.
William Dias BelangeroMedical Science Faculty of the State University of Campinas, Campinas, Brazil.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeThis systematic review, meta-analysis, and meta-regression aims to determine whether surgical treatment for proximal humeral fractures is superior to non-surgical treatment regarding pain, functionality, complications, and new surgery rates.

methodsWe systematically reviewed clinical trials from PubMed (MEDLINE), EMBASE, Web of Science, Scopus, and Cochrane up to April 2024. Data comparing surgical or conservative of proximal humeral fractures were retrieved for outcomes of pain, functionality, adverse events, and new surgeries. We conducted meta-analyses and meta-regressions using average age as the independent variable (x-axis) and the main outcomes as the dependent variable (y-axis). For all analyses, a p value lower than 0.05 was considered statistically significant.

resultsThirteen articles were included in the final analysis, with most follow-up times occurring at 3, 4, 6, 12, and 24 months. The surgical interventions included ORIF, conventional arthroplasty or reversed. Significant differences favoring of surgery were found for functionality at 6 months (SMD = - 0.238; 95% CI - 0.381 to - 0.096, p = 0.001), and for Constant score at 12 months (RMD = - 4.077; 95% CI - 7.034 to - 1.120, p = 0.007). Subgroup analysis showed significant results favoring arthroplasty at 12 months for the Constant score (RMD = - 4.563; 95% CI - 8.104 to - 1.023, p = 0.012). Meta-analysis for complications indicated that the surgery group had significantly higher odds of complications (OR 4.20; 95% CI 2.054-8.591, p < 0.001). The occurrence of osteonecrosis showed no difference between the surgical and conservative groups (OR 0.57; 95% CI 0.167-2.012, p = 0.390). The odds ratio of reoperation were five times higher in the surgical group (OR 5.31; 95% CI 2.467-11.430, p < 0.001). Meta-regressions demonstrated a significant relationship between age and pain, functionality and quality of life at 12-months, with worse results in the conservative group as age increased.

conclusionThe findings indicate a beneficial effect of surgery for proximal humeral fractures, but only for functionality scores at specific time points. However, the reoperation and complication rates were higher in the surgical group. With increasing age, the outcomes tend to be worse for the conservative group. LEVEL OF EVIDENCE: 1A Systematic review of RCTs.

Indexed as

Shoulder FracturesAgedConservative TreatmentHumansPostoperative ComplicationsReoperationTreatment OutcomeArthroplastyConservative treatmentOrthopedic proceduresReoperationShoulder fractures

Identifiers

PMID39775965

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.