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Conservative versus Operative Management of Complex Proximal Humeral Fractures: A Meta-analysis

Background The optimal management of complex proximal humeral fractures is debatable. The present study uses meta-analytical techniques to compare conservative and operative management of proximal humeral fractures with respect to morbidity and functional outcomes. Methods Studies published between 1970 and 2007 comparing conservative and operative treatment of proximal humeral fractures were included. The end points evaluated were morbidity and functional outcomes. A random effects model was used and sensitivity analysis was performed to account for bias in patient selection. Results Ten studies matched the selection criteria, reporting on 486 patients. Two hundred and nineteen (45%) were managed conservatively, 174 (36%) underwent operative fixation and 93 (19%) underwent hemiarthroplasty. Mean follow-up ranged from 6 months to 156 months. No significant difference was demonstrated in post-treatment Constant scores (weighted mean difference = 1.62, –7.12, 10.36), rate of avascular necrosis [odds ratio (OR) = 0.92, confidence interval (CI) = 0.37–2.30] ongoing pain or non-union (OR = 1.28, CI = 0.11–15.46) between the groups. These findings remained consistent when considering studies matched for three- and four-part fractures and fracture dislocations. Conclusion On the basis of available comparative data, there is no demonstrable difference in outcomes between fractures managed surgically or conservatively. There is a need for large, randomised trials to guide management of these fractures.