Comparison Of Curative Effect Between Surgery And Nonsurgical Treatment Of 4-part Proximal Humeral Fractures: A Meta-analysis

Objective:To search and evaluate the curative effect to four-part proximal humeral fractures between operation or nonoperation by Meta-analysis.Method:The Cochrane Library, Pubmed,,Ovid,Science Direct, Web of Science, Springer,CNKI, VIP, Wan Fang Data, and CBM were searched for studies published between 1970 and 2014,6 reporting outcomes of the treatment of four-part proximal humerus fractures. And we handsearched the “Chinese Journal of Orthopaedics ”, “Chinese Journal of Orthopaedic Trauma ”, “Chinese Journal of Trauma”, and “Chinese Journal of Reparative and Reconstructive Surgery ” to identify studies related to the treatment of four-part proximal humerus fractures. According to the standards of the Cochrane Collaboration, we should assess the heterogeneity.Level of test was set at P≤0.01.If heterogeneity existed, a random-effect model was used to assessed the overall estimate. Otherwise, a fixed-effect model was chosen. Continuous variable was analysed using the weighted mean differences(WMD) with its 95% confidence interval(CI), whereas dichotomous data were analyzed using the odds ratio(OR) measure and its 95% CI.We assessed for potential publication bias by using the tool the Cochrane Collaboration recommended. Data were collected independently by two reviewers. A third reviewer adjudicated any disagreement about extracted data. Then data were checked and entered into the Review Manager(Version 5.0.Cochrance Collaboration) database for further analysis.Results:We identified 182 potentially relevant citations from the initial literature search. After independently revewing the full-text,14 trials involving 311 patients(175 operative cases and136 nonoperative cases) were identified..Those trials were performed during the period between 1984 and 2013. There were 4 randomized controlled trials and 10 non-randomized controlled trials. Only four randomized controlled trial(RCT) and the rest were cohort studies.The combined WMD of constant score was15.04,95%CI[-0.89,30.98]). The total complication rate(OR1.50, 95%CI[0.34, 6.58]) The avascular necrosis rate(OR 0.47,95%CI[0.14,1.60]).The additional surgery rate(OR 2.34, 95%CI[0.51,10.83]). There were no statistical significance of the above indexes. There was statistical significance in the excellent rate(OR 3.98,95%CI[1.56,10.14]).Conclusions:Compared with nonoperation, patients with operation could obtain better results in the excellent rate. The results of surgery and nonsurgical treatment to 4-part proximal humeral fractures are the same in the incidence of adverse events.Operation is suggested to be applied.