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Review
. 2022 Sep 29:9:978798.
doi: 10.3389/fsurg.2022.978798. eCollection 2022.

Different treatments for 3- or 4-part proximal humeral fractures in the elderly patients: A Bayesian network meta-analysis of randomized controlled trials

Jiale Guo  1 , Caiju Peng  1 , Ziyan Hu  1 , Yehai Li  1
Affiliations
Review

Different treatments for 3- or 4-part proximal humeral fractures in the elderly patients: A Bayesian network meta-analysis of randomized controlled trials

Jiale Guo et al. Front Surg. .

Abstract

Background: Proximal humeral fractures are the third most common fracture in the body, and their incidence is rising year by year as the population ages. However, the treatment of the proximal humerus in parts 3 and 4 is still debatable, necessitating a network meta-analysis to determine the best treatment for each treatment modality.

Methods: We searched PubMed, Embase, Cochrane Library for randomized controlled trials on proximal humeral fractures up to June 21, 2022. We performed data extraction and literature quality assessment by two independent authors and extracted constant score and reoperation rate as indicators for evaluation. Stata software, Revman software, JAGS software and the R-based BlandAltmanLeh package, gemtc package and riags package were used to perform this Bayesian network meta-analysis.

Results: Following screening, 11 papers with a total of 648 participants were included in the analysis. The SUCRA values for the constant score were in the following order: RSA, IMN, Conservative, HA, and LP, and the SUCRA values for the reoperation rate were LP, HA, IMN, Conservative, and RSA.

Conclusion: The elderly with 3- or 4-part proximal humeral fractures should consider RSA because it received the best evaluation ranking in terms of constant score and reoperation rate.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022341209, identifier: CRD42022341209.

Keywords: conservative; hemiarthroplasty; intramedullary nails; locking plates; proximal humeral fractures; reverse shoulder arthroplasty.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the trail selection.
Figure 2
Figure 2
Risk of bias summary.
Figure 3
Figure 3
Network of the comparisons for the Bayesian network meta-analysis.
Figure 4
Figure 4
Diagnostic plot.
Figure 5
Figure 5
Trace, and density plot.
Figure 6
Figure 6
Rank probability of constant score.
Figure 7
Figure 7
SUCRA values of constant score.
Figure 8
Figure 8
Rank probability of reoperation.
Figure 9
Figure 9
SUCRA values of reoperation.
Figure 10
Figure 10
Bland–Altman diagram.
Figure 11
Figure 11
Inconsistency plot of this network meta-analysis (constant score).
Figure 12
Figure 12
Heterogeneity plot of this network meta-analysis (constant score).
See this image and copyright information in PMC

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References

    1. Bell JE, Leung BC, Spratt KF, Koval KJ, Weinstein JD, Goodman DC, et al. Trends and variation in incidence, surgical treatment, and repeat surgery of proximal humeral fractures in the elderly. J Bone Joint Surg Am. (2011) 93(2):121–31. 10.2106/jbjs.I.01505 - DOI - PMC - PubMed
    1. Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. (2006) 37(8):691–7. 10.1016/j.injury.2006.04.130 - DOI - PubMed
    1. Ratti C, Vulcano E, La Barbera G, Canton G, Murena L, Cherubino P. The incidence of fragility fractures in Italy. Aging Clin Exp Res. (2013) 25(Suppl 1):S13–4. 10.1007/s40520-013-0071-4 - DOI - PubMed
    1. Siggeirsdottir K, Aspelund T, Jonsson BY, Mogensen B, Gudmundsson EF, Gudnason V, et al. Epidemiology of fractures in Iceland and secular trends in major osteoporotic fractures 1989-2008. Osteoporos Int. (2014) 25(1):211–9. 10.1007/s00198-013-2422-6 - DOI - PubMed
    1. Leino OK, Lehtimäki KK, Mäkelä K, Äärimaa V, Ekman E. Proximal humeral fractures in Finland: trends in the incidence and methods of treatment between 1997 and 2019. Bone Joint J. (2022) 104-b(1):150–6. 10.1302/0301-620x.104b1.Bjj-2021-0987.R1 - DOI - PubMed

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