Interventions for treating proximal humeral fractures in adults (Review)

T A B L E O F C O N T E N T S
HEADER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
PLAIN LANGUAGE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
AUTHORS’ CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
CHARACTERISTICS OF STUDIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
DATA AND ANALYSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Analysis 1.1. Comparison 1 Early mobilisation within 1 week versus immobilisation for 3 weeks, Outcome 1 Number of
treatment sessions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Analysis 1.2. Comparison 1 Early mobilisation within 1 week versus immobilisation for 3 weeks, Outcome 2 SF-36 scores:
pain & physical dimensions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Analysis 1.3. Comparison 1 Early mobilisation within 1 week versus immobilisation for 3 weeks, Outcome 3 Constant
shoulder score (ratio of affected/unaffected arm). . . . . . . . . . . . . . . . . . . . . . . 41
Analysis 1.4. Comparison 1 Early mobilisation within 1 week versus immobilisation for 3 weeks, Outcome 4 Shoulder
disability: Croft Shoulder Disability Score. . . . . . . . . . . . . . . . . . . . . . . . . 41
Analysis 1.5. Comparison 1 Early mobilisation within 1 week versus immobilisation for 3 weeks, Outcome 5 Croft
Shoulder Disability Score: individual problems at 2 years. . . . . . . . . . . . . . . . . . . . 42
Analysis 1.6. Comparison 1 Early mobilisation within 1 week versus immobilisation for 3 weeks, Outcome 6 Frozen
shoulder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Analysis 2.1. Comparison 2 Immobilisation for 1 week versus immobilisation for 3 weeks, Outcome 1 Reflex sympathetic
dystrophy at 6 months. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Analysis 3.1. Comparison 3 Gilchrist bandage versus ’Classic’ Desault bandage, Outcome 1 Problems with bandages.
Analysis 3.2. Comparison 3 Gilchrist bandage versus ’Classic’ Desault bandage, Outcome 2 Fracture displacement by 3
44
weeks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Analysis 3.3. Comparison 3 Gilchrist bandage versus ’Classic’ Desault bandage, Outcome 3 Poor or bad rating by patient at
fracture consolidation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Analysis 4.1. Comparison 4 Instructed self physiotherapy versus conventional physiotherapy, Outcome 1 Pain at one year
(scale 0-8: maximum pain). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Analysis 4.2. Comparison 4 Instructed self physiotherapy versus conventional physiotherapy, Outcome 2 Severe or
moderate pain at 3 months. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Analysis 4.3. Comparison 4 Instructed self physiotherapy versus conventional physiotherapy, Outcome 3 Requested change
of therapy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Analysis 4.4. Comparison 4 Instructed self physiotherapy versus conventional physiotherapy, Outcome 4 Failure of
treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Analysis 4.5. Comparison 4 Instructed self physiotherapy versus conventional physiotherapy, Outcome 5 Neer’s rating (0-
100: best) at 3 months. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Analysis 4.6. Comparison 4 Instructed self physiotherapy versus conventional physiotherapy, Outcome 6 Active glenohumeral
elevation (degrees). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Analysis 5.1. Comparison 5 Reduction and external fixation versus closed reduction, Outcome 1 Treatment failure by 1
month. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Analysis 5.2. Comparison 5 Reduction and external fixation versus closed reduction, Outcome 2 Poor or unsatisfactory
function at 1 year (Neer rating). . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Analysis 5.3. Comparison 5 Reduction and external fixation versus closed reduction, Outcome 3 Complications. . . 49
Analysis 6.1. Comparison 6 Cerclage or tension band wiring versus conservative treatment (displaced 3 and 4 part fractures),
Outcome 1 Complications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Interventions for treating proximal humeral fractures in adults (Review)
Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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