European Journal of Orthopaedic Surgery and Traumatology最新文献

{"title":"Immediate full weight-bearing, reduced perioperative morbidity and mortality after surgery in the treatment of distal femur fractures using a standard lateral plate plus a helical moulded medial plate ostheosynthesis.","authors":"Guillem Molina-Olivella, Miquel Videla-Cés, Sebastian Videla","doi":"10.1007/s00590-025-04176-w","DOIUrl":"https://doi.org/10.1007/s00590-025-04176-w","url":null,"abstract":"<p><strong>Purpose: </strong>To describe our clinical and functional experience in treating distal femur fractures using double helical plating with immediate full weight-bearing.</p><p><strong>Method: </strong>A retrospective, unicentric, case series study, based on data from patients with distal femur fractures who underwent surgery between 1 November 2019 and 31 January 2024. All patients who had a distal femur fracture and fulfil the criterion of previous ambulation were surgically treated using a standard lateral plate plus a helical moulded medial plate osteosynthesis through a MIPO technique with immediate full weight-bearing. We assessed length of surgery, blood loss during surgery, ambulation at 48 h after surgery; and at 6 months: clinical ('excellent' ambulation) and functional success (motion and malalignment), mortality and radiological outcome. A descriptive analysis was performed.</p><p><strong>Results: </strong>Seventy-three patients were diagnosed with distal femur fracture, of which 68 (7 men, 61 women, with a median age of 84 (range, 50-99) years old) were included in the study. Median length of surgery was 132 (range, 69-235) min, median blood loss during surgery was - 2.2 (range, 0.2-5) g/dL. At 4 days, all (100%) patients ambulated. At 6 months, clinical and functional success were 59.68% (95% CI 47.3-71.0%) and 98.38% (95% CI 91.4-99.7%), respectively; 6 (8.8%, 95% CI 4.1-17.9%) patients died, all the remaining had an excellent/good radiological assessment.</p><p><strong>Conclusion: </strong>Double helical plating for treating distal femur fractures is a stable and minimally invasive osteosynthesis technique, which enables immediately full weight-bearing with a minimum risk of secondary displacement or fixation failure. This technique could be considered as a good option for the fixation of distal femur fractures in frail patients.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"35 1","pages":"60"},"PeriodicalIF":1.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of software-assisted and freehand methods of rotational assessment for diaphyseal tibia fractures.","authors":"Christian Blough, Kevin Huang, Samuel Raszka, Sapan Shah, John Garlich, Charles Moon, Geoffrey Marecek","doi":"10.1007/s00590-025-04175-x","DOIUrl":"10.1007/s00590-025-04175-x","url":null,"abstract":"<p><strong>Objective: </strong>Accurate rotational reduction following tibial shaft fracture fixation is absent in up to 36% of cases yet may be critical for lower extremity biomechanics. The objective of this cadaveric study was to compare the results of freehand methods of reduction with software-assisted reduction.</p><p><strong>Methods: </strong>Four fellowship-trained orthopaedic trauma surgeons attempted rotational correction in a cadaveric model with fluoroscopic assistance (without radiographic visualization of the fracture site) using (1) their method of choice (MoC) and (2) software assistance (SA). After correction, deviation from baseline rotation was calculated.</p><p><strong>Results: </strong>The mean difference between the two methods (MoC-SA) was - 0.2° which was not statistically significant. There was no difference in variability between methods. The rate of clinically relevant rotational deformity (> 15°) was 28% using MoC and 31% using SA.</p><p><strong>Conclusion: </strong>Rotational assessment of diaphyseal tibia fractures in this cadaveric model was not significantly different when compared between method of choice and software augmentation.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"35 1","pages":"59"},"PeriodicalIF":1.4,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of tranexamic acid and cryotherapy on acute postoperative pain and blood loss: a randomized controlled study following total knee arthroplasty.","authors":"Sönmez Sağlam, Zekeriya Okan Karaduman, Mehmet Arıcan, Mücahid Osman Yücel, Raşit Emin Dalaslan, Sengul Cangur, Veysel Uludag","doi":"10.1007/s00590-025-04174-y","DOIUrl":"https://doi.org/10.1007/s00590-025-04174-y","url":null,"abstract":"<p><strong>Purpose: </strong>Blood loss and pain management are significant concerns in total knee arthroplasty (TKA). Tranexamic acid (TA) and cryotherapy have been used separately to address these issues, but their comparative effectiveness is not well studied. This study aimed to evaluate the efficacy of intravenous TA and cryotherapy in reducing blood loss and improving clinical outcomes after TKA.</p><p><strong>Methods: </strong>A randomized controlled trial with 76 patients assigned to three groups: Group 1 received pre- and postoperative cryotherapy, Group 2 received intravenous tranexamic acid (TA), and Group 3 (control) received a standard cold pack. Hemoglobin (Hb), hematocrit (Hct), prothrombin time, international normalized ratio (INR), knee flexion and extension angles, and visual analog scale (VAS) pain scores were monitored preoperatively and postoperatively at 6, 24, and 48 h.</p><p><strong>Results: </strong>The mean age of patients was 65 ± 7 years. The tranexamic acid group showed significantly lower blood loss compared to the control group (p < 0.001). Knee flexion and extension angles were significantly better in the cryotherapy group compared to the control group (p < 0.001). VAS pain scores were significantly lower in the cryotherapy group at all time points compared to both the tranexamic acid and control groups (p < 0.001).</p><p><strong>Conclusion: </strong>Both tranexamic acid and cryotherapy are effective in reducing blood loss and improving clinical outcomes following TKA. Tranexamic acid significantly reduces blood loss, while cryotherapy effectively manages postoperative pain and range of motion. These methods can enhance patient recovery after TKA.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"35 1","pages":"58"},"PeriodicalIF":1.4,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment strategies for soft tissue injuries associated with blunt brachial artery injury.","authors":"Yuta Izawa, Kentaro Futamura, Masahiro Nishida, Hiroko Murakami, Kazuo Sato, Yoshihiko Tsuchida","doi":"10.1007/s00590-025-04179-7","DOIUrl":"https://doi.org/10.1007/s00590-025-04179-7","url":null,"abstract":"<p><strong>Introduction: </strong>Blunt brachial artery injuries (BAI) require reconstruction with an extensive vein graft due to the wide area of arterial damage. In the upper arm, safe options for pedicle flaps are limited, and selecting recipient vessels for free-flap surgery is challenging, complicating the treatment of soft tissue injuries associated with blunt BAI. This study aimed to analyze the characteristics and soft tissue reconstruction of blunt BAI and propose treatment strategies for treating associated soft tissue injuries.</p><p><strong>Methods: </strong>Patients with blunt BAI who treated between August 2013 and April 2024 were included. Blunt BAI cases were classified into three groups (Type1A, Type1B, and Type2) based on soft tissue injury localization and elbow flexion reconstruction necessity. Patient demographics, treatment details, and treatment outcomes were investigated.</p><p><strong>Results: </strong>Seven patients were included to this study. There were two cases of Type1A, three Type1B, and two Type2. Three cases of Type1B underwent soft tissue reconstruction using pedicled latissimus dorsi flap and concurrent reconstruction of the elbow flexion. One case of Type2 was treated with free latissimus dorsi flap using AV loop, and the remaining case of Type2 was performed forearm amputation.</p><p><strong>Conclusion: </strong>This study examined the treatment details of seven patients with blunt BAI. If a soft tissue injury is localized to the upper arm, it can be treated with a pedicle flap. However, if the damage extends beyond the forearm, a free flap is essential and some ingenuity is required to select the recipient blood vessel.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"35 1","pages":"57"},"PeriodicalIF":1.4,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insulin dependence as an independent predictor of complications following surgical treatment of distal radius fracture.","authors":"Allen Bramian, Kenny Ling, Dmitriy Butsenko, David Komatsu, Edward Wang","doi":"10.1007/s00590-025-04173-z","DOIUrl":"https://doi.org/10.1007/s00590-025-04173-z","url":null,"abstract":"<p><strong>Purpose: </strong>Diabetes mellitus (DM) is a well-established risk factor for postoperative complications. Distal radius fractures (DRFs) are a common orthopedic injury and often require open reduction and internal fixation (ORIF). The rise of ORIF utilization warrants investigation into factors that may expose patients to postoperative complications following DRF ORIF.</p><p><strong>Methods: </strong>We queried the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for cases of DRF ORIF between 2015 and 2021. Cases were stratified into cohorts based on diabetes mellitus (DM) status. The DM cohort was further stratified into non-insulin-dependent DM (NIDDM) and insulin-dependent DM (IDDM) groups. Bivariate logistic regression was performed to compare patient demographics, comorbidities, and 30-day postoperative complications. Multivariate logistic regressions were performed to identify associations between diabetes mellitus status and postoperative complications.</p><p><strong>Results: </strong>A total of 27,761 cases of DRF ORIF were identified from 2015 to 2021. After exclusion criteria were applied, 25,971 cases remained, of which 2169 (8.4%) cases had DM and 23,802 (91.6%) cases were free of DM. Within the DM cohort, there were 1392 cases in the NIDDM subgroup and 777 cases in the IDDM subgroup. Relative to the cohort without diabetes, the IDDM cohort was independently associated with sepsis, septic shock, reintubation, myocardial infarction, blood transfusion, failure to wean off mechanical ventilation, readmission, and nonhome discharge.</p><p><strong>Conclusion: </strong>Having IDDM was independently associated with higher rates of postoperative sepsis, septic shock, reintubation, myocardial infarction, blood transfusion, failure to wean off ventilation, readmission, and nonhome discharge when compared to the cohort without diabetes following DRF ORIF.</p><p><strong>Level of evidence: </strong>Level III; Retrospective cohort comparison; Prognosis study.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"35 1","pages":"56"},"PeriodicalIF":1.4,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Oxford hip score demonstrates moderate ceiling effects at one and two years after total hip arthroplasty: which patients are at risk and does it matter?","authors":"N D Clement, S Jones, B Qaddoura, I Afzal, D F Kader","doi":"10.1007/s00590-024-04155-7","DOIUrl":"https://doi.org/10.1007/s00590-024-04155-7","url":null,"abstract":"<p><strong>Background: </strong>The aim was to assess whether the postoperative Oxford Hip Score (OHS) demonstrated a ceiling effect at 1 or 2 years after total hip arthroplasty (THA) and to identify which patients are more likely to achieve a ceiling score and whether this limits assessment of their outcome.</p><p><strong>Methods: </strong>A retrospective cohort of 7871 patients undergoing primary THA was identified from an established arthroplasty database. Patient demographics, ASA grade, socioeconomic status, OHS and EuroQol questionnaire were collected preoperatively and at 1 and 2 years postoperatively. Regression analysis was used to identify independent preoperative factors associated with achieving a ceiling score. Receiver operating characteristic curves were used to identify preoperative OHS's that predicted a postoperative ceiling score.</p><p><strong>Results: </strong>The ceiling effect (proportion achieving the maximal score) at 1 year was 21.8% (n = 1372) which increased significantly (p < 0.001) to 26.6% (n = 1569) at 2 years. Female gender (p ≤ 0.028), younger age (p < 0.001), decreasing socioeconomic deprivation (only for 2-year OHS), a better preoperative OHS (p < 0.001) or EQ-VAS (p < 0.001) were independently associated with a ceiling OHS postoperatively. The preoperative OHS was demonstrated to be a  poor discriminator of achieving postoperative ceiling score at 1 year (AUC 62.4%, 95% CI 60.7 to 64.1, p < 0.001) and 2 years (AUC 61.5%, 95% CI 60.0 to 63.2). Those achieving a postoperative ceiling OHS at 1 and 2 years had statistically significant (p < 0.001) greater improvements in their OHS, EQ-5D and EQ-VAS and were more likely to have achieved a minimal important change in their OHS relative to their preoperative baseline and a postoperative patient acceptable symptom state.</p><p><strong>Conclusion: </strong>The OHS demonstrated moderate ceiling effects at both 1 and 2 years following THA, and the preoperative score was a predictor of achieving a ceiling score. However, it would seem the ceiling effect did not limit the potential for improvements relative to baseline and achieving clinically meaningful values in the OHS.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"35 1","pages":"54"},"PeriodicalIF":1.4,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pain perception, opioid consumption and mobility following lateral compression pelvic ring injuries: a two-year prospective cohort study.","authors":"Camryn C Therrien, Kaj Ten Duis, Jean-Paul P M de Vries, Inge H F Reininga, Frank F A IJpma","doi":"10.1007/s00590-024-04128-w","DOIUrl":"10.1007/s00590-024-04128-w","url":null,"abstract":"<p><strong>Purpose: </strong>A prospective longitudinal cohort study was performed to gain insight into the course of recovery in terms of pain, opioid consumption, and mobility in patients with a lateral compression (LC) pelvic injury.</p><p><strong>Methods: </strong>Adult patients with an LC injury, without any cognitive disorders or limited mobility and who could communicate in Dutch were asked to participate. Pain in terms of NRS (numeric rating scale, range 0-10), opioid use and mobility were recorded at eight time points: at hospital admission, and three days, one week, six weeks, three months, six months, one year and two years after the injury. A sub-analysis was performed for nonoperatively and operatively treated patients.</p><p><strong>Results: </strong>Ninety-seven patients were included, of which 23 (24%) were treated operatively and 74 (76%) conservatively. Pain at rest and exertion, were highest upon admission (mean NRS of 3.4 (SD = 2.6) and 4.4 (SD = 2.8), respectively) but decreased within six weeks (mean NRS of 0.8 (SD = 1.6) and 2.0 (2.0), respectively). After two years, the mean NRS was 0.5 (SD = 1.6) and 0.9 (SD = 2.1), respectively. Upon admission, 85% were given opioids, however only 11% used opioids after three months and 4% after two years. At three months, 35% were walking using walking aids and 58% were walking independently. After two years, 98% were walking independently.</p><p><strong>Conclusions: </strong>Pain rapidly decreased within the first six weeks. Most patients did not need opioids after three months. Furthermore, most patients were walking with walking aids after six weeks. After two years, few patients experienced pain, used opioids or had difficulties walking.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"35 1","pages":"55"},"PeriodicalIF":1.4,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11724773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of tibiofibular syndesmosis stability following treatment of proximal, middle, and distal third fibula fractures.","authors":"Sean Thomas, Garrett Berger, Brendan O'Leary, Zachary Brumm, Alexandra K Schwartz, William T Kent","doi":"10.1007/s00590-024-04148-6","DOIUrl":"10.1007/s00590-024-04148-6","url":null,"abstract":"<p><strong>Purpose: </strong>While treatment modalities for Maisonneuve fractures involving the proximal third of the fibula are established, no studies to date have reported outcomes associated with syndesmotic-only fixation of middle third fibular shaft fractures. The purpose of this study was to evaluate outcomes associated with syndesmotic-only fixation in the treatment of Maisonneuve fractures involving the middle third of the fibula.</p><p><strong>Methods: </strong>A retrospective review was conducted on 257 cases of syndesmotic ankle instability with associated fibular fractures at a level 1 trauma center between 2013 and 2023. Patients were divided into cohorts based on fibular fracture location in the proximal, middle, or distal third of the fibula. The Chi-square test of independence, two-sample t-test, and analysis of variance were used to compare outcome measures between cohorts.</p><p><strong>Results: </strong>Sixty-six patients were identified including 48% (n = 32) with proximal third fibular fractures, 20% (n = 13) with middle third fibular fractures, and 32% (n = 21) with distal third fibular fractures. Rates of infection, loss of reduction, wound healing complications, and reoperation did not vary significantly between cohorts. Functional outcome measures including range of motion, time to weight-bearing, and tibiofibular/medial clear space measurements at final follow-up were similar across cohorts.</p><p><strong>Conclusion: </strong>Patients with Maisonneuve fractures involving the middle third of the fibula demonstrated positive outcomes with syndesmotic fixation alone, with no documented cases of infection, loss of reduction, or wound healing issues. By demonstrating maintenance of anatomic reduction and low rates of complications, our results support the use of syndesmotic-only fixation in the treatment of middle third Maisonneuve fractures.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"35 1","pages":"53"},"PeriodicalIF":1.4,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11724774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Value driven outcome (VDO) assessment for the treatment of olecranon fractures.","authors":"Makoa Mau, Tyler Thorne, Minkyoung Yoo, Silvia Soule, Richard E Nelson, Timothy Torrez, Michael Amick, Kayla Gates, Eleanor Sato, David L Rothberg, Lucas S Marchand","doi":"10.1007/s00590-024-04151-x","DOIUrl":"https://doi.org/10.1007/s00590-024-04151-x","url":null,"abstract":"<p><strong>Purpose: </strong>Controversy remains about the ideal construct for certain olecranon fractures. The purpose of this study was to compare cost-effectiveness with the value driven outcomes tool between fixation strategies of olecranon fractures.</p><p><strong>Methods: </strong>All surgically treated isolated proximal ulna fractures (CPT code 24,685) at a level 1 trauma center from 2013 to 2023 were retrospectively reviewed. Patients with concomitant radial/ulnar shaft fractures and ligamentous elbow injuries requiring repair were excluded. Demographics, outcomes, initial, downstream (costs secondary to index surgery), and combined cost were compared between plate andintramedullary (IM) screw constructs. Costs included charges to the hospital from facility, implant, supply, pharmacy, imaging, and other service use.</p><p><strong>Results: </strong>102 patients with average age of 51 were included: 84 olecranon-specific plates and18 IM screws. Average follow-up was 14.62 ± 16.79 months. There were differences in CCI (p = 0.006). Plate initial and combined cost was significantly greater than an IM screw (1.26x, p = 0.007; 1.49x, p = 0.009, respectively). Using IM screws for reference and controlling for demographics and fracture patterns, treatment with a plate was more expensive at downstream and combined total cost (56.28x, p = 0.04;76.73x, p = 0.03, respectively).</p><p><strong>Conclusion: </strong>Olecranon plate fixation is associated with increased downstream and overall cost to the healthcare system. When indicated, other forms of fixation should be considered due to lower costs while still maintaining satisfactory outcomes.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"35 1","pages":"52"},"PeriodicalIF":1.4,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is surgical treatment better than non-surgical treatment for proximal humeral fracture in elderly people? A meta-analysis and meta-regression.","authors":"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","doi":"10.1007/s00590-024-04170-8","DOIUrl":"10.1007/s00590-024-04170-8","url":null,"abstract":"<p><strong>Purpose: </strong>This 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.</p><p><strong>Methods: </strong>We 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.</p><p><strong>Results: </strong>Thirteen 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.</p><p><strong>Conclusion: </strong>The 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.</p><p><strong>Level of evidence: </strong>1A Systematic review of RCTs.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"35 1","pages":"51"},"PeriodicalIF":1.4,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}