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Interventions for treating proximal humeral fractures in adults (Review)

Interventions for treating proximal humeral fractures in adults (Review)

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[Intervention <strong>Review</strong>]<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><br />

<strong>adults</strong><br />

Helen HG Handoll 1 , Rajan Madhok 2<br />

1 Centre <strong>for</strong> Rehabilitation Sciences (CRS), Research Institute <strong>for</strong> Health Sciences and Social Care, University of Teesside, Middlesborough,<br />

UK. 2 Cochrane Bone, Jo<strong>in</strong>t and Muscle Trauma Group, University of Manchester, Manchester, UK<br />

Contact address: Helen HG Handoll, Centre <strong>for</strong> Rehabilitation Sciences (CRS), Research Institute <strong>for</strong> Health Sciences and Social<br />

Care, University of Teesside, School of Health and Social Care, Middlesborough, Tees Valley, TS1 3BA, UK. h.handoll@tees.ac.uk.<br />

H.Handoll@ed.ac.uk.<br />

Editorial group: Cochrane Bone, Jo<strong>in</strong>t and Muscle Trauma Group.<br />

Publication status and date: Edited (no change to conclusions), published <strong>in</strong> Issue 4, 2008.<br />

<strong>Review</strong> content assessed as up-to-date: 28 September 2006.<br />

Citation: Handoll HHG, Madhok R. <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>. Cochrane Database of Systematic<br />

<strong>Review</strong>s 2003, Issue 4. Art. No.: CD000434. DOI: 10.1002/14651858.CD000434.<br />

Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.<br />

Background<br />

A B S T R A C T<br />

Proximal <strong>humeral</strong> <strong>fractures</strong> are common. The management, <strong>in</strong>clud<strong>in</strong>g surgical <strong>in</strong>tervention, of these <strong>in</strong>juries varies widely.<br />

Objectives<br />

To review the evidence support<strong>in</strong>g the various <strong>in</strong>terventions <strong>for</strong> <strong>treat<strong>in</strong>g</strong> <strong>proximal</strong> <strong>humeral</strong> <strong>fractures</strong>.<br />

Search strategy<br />

We searched the Cochrane Bone, Jo<strong>in</strong>t and Muscle Trauma Group Specialised Register (September 2006), the Cochrane Central<br />

Register of Controlled Trials, MEDLINE, EMBASE and other databases, and bibliographies of trial reports. The search ended <strong>in</strong><br />

September 2006.<br />

Selection criteria<br />

All randomised controlled trials pert<strong>in</strong>ent to the management of <strong>proximal</strong> <strong>humeral</strong> <strong>fractures</strong> were selected.<br />

Data collection and analysis<br />

Two people per<strong>for</strong>med <strong>in</strong>dependent quality assessment and data extraction. Trial heterogeneity prevented meta-analysis.<br />

Ma<strong>in</strong> results<br />

Twelve small randomised trials with 578 participants were <strong>in</strong>cluded. Bias <strong>in</strong> these trials could not be ruled out.<br />

Seven trials evaluated conservative treatment. There was very limited evidence that the type of bandage used had any <strong>in</strong>fluence on the<br />

time to fracture union and the functional end result. However, an arm sl<strong>in</strong>g was generally more com<strong>for</strong>table than a body bandage.<br />

There was some evidence that ’immediate’ physiotherapy compared with that delayed until after three weeks immobilisation resulted<br />

<strong>in</strong> less pa<strong>in</strong> and faster and potentially better recovery <strong>in</strong> people with undisplaced two-part <strong>fractures</strong>. Similarly, there was evidence<br />

that mobilisation at one week <strong>in</strong>stead of three weeks alleviated short term pa<strong>in</strong> without compromis<strong>in</strong>g long term outcome. Two trials<br />

provided some evidence that unsupervised patients could generally achieve a satisfactory outcome when given sufficient <strong>in</strong>struction to<br />

pursue an adequate physiotherapy programme.<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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