Objectives: 

Differences in function, pain, and reoperation rates were compared between the following treatment options: (1) operative vs. nonoperative treatment and (2) various surgical treatments including open reduction internal fixation, intramedullary nail, hemiarthroplasty (HA), and reverse shoulder arthroplasty (RSA).

Data Sources: 

MEDLINE, Embase, and Cochrane were searched through February 1, 2022. All English-language randomized trials comparing operative and nonoperative treatment of proximal humeral fractures with a control group in patients 18 years or older were included.

Data Extraction: 

Demographic data, functional and pain scores and re-operation rates were extracted. Study quality was determined with the Cochran risk of bias tool and the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE). Heterogeneity was determined with the I-squared statistic.

Data Synthesis: 

Meta-analysis of included studies using mean difference and odds ratios where appropriate.

Conclusions: 

Surgical treatment with either locked plates or HA results in similar functional scores and pain outcomes as nonoperative treatment, although plates were associated with higher reoperation rates in 3-part and 4-part fractures. In 3-part and 4-part fractures, RSA results in higher function and pain scores compared with HA. Further high-quality trials should focus on RSA, and further study is required to better define the role of open reduction internal fixation in the younger patient population.

Level of Evidence: 

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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成人肱骨近端骨折的处理：系统评价和荟萃分析

目标： 

比较以下治疗方案在功能、疼痛和再手术率方面的差异：(1) 手术与非手术治疗和 (2) 各种手术治疗，包括切开复位内固定、髓内钉、股骨头置换术 (HA) 和反肩关节置换术（RSA）。

数据源： 

检索了截至 2022 年 2 月 1 日的 MEDLINE、Embase 和 Cochrane。纳入了所有英语随机试验，这些试验将肱骨近端骨折的手术和非手术治疗与对照组进行了比较，受试者为 18 岁或以上的患者。

数据提取： 

提取人口统计学数据、功能和疼痛评分以及再手术率。研究质量由 Cochran 偏倚风险工具和推荐、评估、开发和评估等级 (GRADE) 确定。异质性由 I 方统计确定。

数据综合： 

在适当的情况下使用平均差和比值比对纳入的研究进行荟萃分析。

结论： 

使用锁定钢板或 HA 的手术治疗与非手术治疗产生相似的功能评分和疼痛结果，尽管钢板与更高的 3 部分和 4 部分骨折的再手术率相关。在 3 部分和 4 部分骨折中，与 HA 相比，RSA 导致更高的功能和疼痛评分。进一步的高质量试验应侧重于 RSA，需要进一步研究以更好地确定切开复位内固定在年轻患者群体中的作用。

证据等级： 

治疗级别 I。有关证据级别的完整描述，请参阅作者说明。