Interventions for treating proximal humeral fractures in adults (Review)
Interventions for treating proximal humeral fractures in adults (Review)
Interventions for treating proximal humeral fractures in adults (Review)
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Zyto 1997 (Cont<strong>in</strong>ued)<br />
Subjective assessment of function <strong>in</strong>clud<strong>in</strong>g ability to carry 5 kg, sleep on <strong>in</strong>jured side, comb hair, per<strong>for</strong>m<br />
personal hygiene<br />
Constant score: overall shoulder function and components (pa<strong>in</strong>, power, range of motion, activities of<br />
daily liv<strong>in</strong>g)<br />
Complications: deep <strong>in</strong>fection, non-union, pulmonary embolism, avascular necrosis of <strong>humeral</strong> head<br />
Mortality<br />
Notes Three patients excluded from 1995 data set (Tornquist 1995) as, on review by Zyto and a radiologist, the<br />
patients did not have 3 or 4 part <strong>fractures</strong> (personal communication).<br />
Zyto’s response to a letter from H. A. Karladani admits that there may have been some <strong>in</strong>accuracy <strong>in</strong> their<br />
classification of the fracture patterns but stressed that the Neer classification system was flawed and that<br />
other factors such as osteoporotic bone need to be considered too.<br />
Risk of bias<br />
Item Authors’ judgement Description<br />
Allocation concealment? Unclear B - Unclear<br />
AO = Arbeitsgeme<strong>in</strong>schaft fur Osteosynthesefragen / Association <strong>for</strong> the Study of Internal Fixation (or ASIF)<br />
AVN = avascular necrosis<br />
A&E = accident and emergency<br />
MI = myocardial <strong>in</strong>farction<br />
PE = pulmonary embolism<br />
Characteristics of excluded studies [ordered by study ID]<br />
Bolano 1995 No <strong>proximal</strong> <strong>humeral</strong> <strong>fractures</strong> <strong>in</strong> randomised trial of <strong>humeral</strong> shaft fracture treatment.<br />
Brownson 2001 This is listed <strong>in</strong> the National Research Register as a multi-centre randomised trial of the management of<br />
displaced surgical neck and displaced shaft <strong>fractures</strong> of the humerus with the Halder <strong>humeral</strong> nail. Contact<br />
with Mr Brownson revealed this to be part of the trial run from Nott<strong>in</strong>gham (see Wallace 2000) which<br />
had been abandoned. Mr Brownson <strong>in</strong>dicated that the very specific <strong>in</strong>clusion criteria (2-part <strong>fractures</strong> with<br />
over 50% displacement) had reduced the potential sample size; patient consent had also been a problem.<br />
Chapman 1997 No <strong>proximal</strong> <strong>humeral</strong> <strong>fractures</strong> <strong>in</strong> randomised trial of <strong>humeral</strong> shaft fracture treatment.<br />
Chiu 1997 No <strong>proximal</strong> <strong>humeral</strong> <strong>fractures</strong> <strong>in</strong> quasi-randomised trial of <strong>humeral</strong> shaft fracture treatment.<br />
de Boer 2003 This is a multi-centre comparative study of locked <strong>in</strong>ternal fixators and non-operative treatment. Not<br />
randomised.<br />
<strong>Interventions</strong> <strong>for</strong> <strong>treat<strong>in</strong>g</strong> <strong>proximal</strong> <strong>humeral</strong> <strong>fractures</strong> <strong>in</strong> <strong>adults</strong> (<strong>Review</strong>)<br />
Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.<br />
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