Reverse arthroplasty compared to hemiarthroplasty and open reduction and internal fixation for displaced proximal humerus fracture in patients above 60: a Bayesian network meta-analysis

IF 2.1 3区医学 Q2 ORTHOPEDICS

Archives of Orthopaedic and Trauma Surgery Pub Date : 2025-10-18 DOI:10.1007/s00402-025-06067-5

Filippo Migliorini, Giuliano Sammaria, Luise Schäfer, Michael Memminger, Francesco Simeone, Nicola Maffulli

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引用次数: 0

Abstract

AbstractSection Introduction

The present Bayesian network meta-analysis compared reverse total shoulder arthroplasty (rTSA) to hemiarthroplasty (HA) and open reduction and internal fixation (ORIF) for displaced proximal humeral fractures (PHF) in patients above 60.

AbstractSection Methods

This study was conducted according to the PRISMA extension statement for reporting systematic reviews incorporating network meta-analyses of healthcare interventions. In December 2024, PubMed, Web of Science, and Embase databases were accessed. No time constraint was set for the search. All clinical studies were accessed comparing rTSA, ORIF and HA for displaced PHF in patients older than 60. Only studies which compared at least two of the interventions of interest were eligible when they reported a minimum of 12 months of follow-up. Two-, three-, and four-part displaced fractures and fractures with a head-splitting component were considered.

AbstractSection Results

Data from 878 procedures were collected. 72% (631 of 878 patients) were women. The mean length of the follow-up was 33.8 ± 14.8 months. The mean age of the patients was 73.4 ± 4.6 years. Between groups, comparability was found in the mean age, the ratio of men to women, the length of the follow-up, and the time elapsed from injury to the procedure. The rTSA demonstrated the lowest rate of complications, followed by HA and ORIF. The rTSA demonstrated the lowest rate of revision, followed by HA and ORIF. Given the limited and heterogeneous data, only complications and revision rates were analysed in the network meta-analysis; functional outcomes were discussed narratively.

AbstractSection Conclusion

In patients above 60 with displaced PHF, rTSA was associated with a lower complication and revision rate than ORIF and HA.

AbstractSection Level of evidence

Level IV, systematic review and meta-analysis.

查看原文本刊更多论文

60岁以上患者肱骨近端移位骨折逆行关节置换术与半关节置换术、切开复位内固定的比较：一项贝叶斯网络meta分析

本贝叶斯网络meta分析比较了逆行全肩关节置换术（rTSA）与半关节置换术（HA）和切开复位内固定（ORIF）治疗60岁以上肱骨近端移位骨折（PHF）的疗效。摘要章节方法本研究是根据PRISMA报告系统评价扩展声明进行的，纳入了医疗保健干预措施的网络meta分析。2024年12月，PubMed、Web of Science和Embase数据库被访问。没有为搜索设置时间限制。所有的临床研究都比较了rTSA、ORIF和HA治疗60岁以上患者的移位性PHF。只有比较了至少两种感兴趣的干预措施的研究在报告至少12个月的随访时才符合条件。考虑了二、三、四部分移位骨折和有劈头成分的骨折。结果共收集878例手术资料。72%（878例患者中的631例）为女性。平均随访时间为33.8±14.8个月。患者平均年龄73.4±4.6岁。在两组之间，在平均年龄、男女比例、随访时间和从受伤到手术的时间上发现了可比性。rTSA的并发症发生率最低，HA和ORIF次之。rTSA的修复率最低，HA和ORIF次之。由于数据有限且异构，网络荟萃分析仅分析并发症和修改率；叙述功能结果。结论在60岁以上移位性PHF患者中，rTSA的并发症和翻修率低于ORIF和HA。【摘要】第四节证据水平、系统评价和荟萃分析。

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来源期刊

Archives of Orthopaedic and Trauma Surgery 医学-外科

CiteScore

4.30

自引率

13.00%

发文量

424

审稿时长

2 months

期刊介绍： "Archives of Orthopaedic and Trauma Surgery" is a rich source of instruction and information for physicians in clinical practice and research in the extensive field of orthopaedics and traumatology. The journal publishes papers that deal with diseases and injuries of the musculoskeletal system from all fields and aspects of medicine. The journal is particularly interested in papers that satisfy the information needs of orthopaedic clinicians and practitioners. The journal places special emphasis on clinical relevance. "Archives of Orthopaedic and Trauma Surgery" is the official journal of the German Speaking Arthroscopy Association (AGA).