الفهرس 
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Abstract
T
he current meta-analysis aimed to compare functional outcomes and quality of life after treatment of displaced 3-part proximal humerus fractures using the locking plates, as compared to non-operative treatment in elderly patients. To obtain this aim, clinical studies revealing the clinical outcome after treatment displaced 3-part proximal humerus fractures in the elderly with at least a 6-month follow-up evaluation that were Published from 1990 to 2021 were included. A total of 7 studies were finally included for analysis.
The results of this meta-analysis revealed no significant differences between conservative treatment and operative treatment as regard constant scores, DASH and VAS scores, range of movement, incidence of complications or non-union.
Outcome of analysis revealed the following:
Five studies reported the outcome of Constant score either after an operative procedure with locking plates or conservative without performing operations.
The pooled analysis of the included studies showed no significant difference between conservative treatment and operative treatment (MD = 0.04; 95% CI:[-0.2, 0.29]; P = 0.748). The pooled studies were heterogeneous (I2 = 83%).
Three studies reported the outcome of the DASH score either after the operative procedure with locking plates or conservative without performing operations. The pooled analysis of the included studies showed no significant difference between conservative treatment and operative treatment (MD = 0.05; 95% CI:[-0.35, 0.25]; P = 0.48). The pooled studies were heterogeneous (I2 = 98%).
Three studies reported the outcome of VAS score either after operative procedure with locking plates or conservative without performing operations. The pooled analysis of the included studies showed no significant difference between conservative treatment and operative treatment (MD = 0.38; 95% CI:[0.07, 0.69]; P = 0.748). The pooled studies were heterogeneous (I2 = 83%).
Two studies reported the outcome of ROM either after the operative procedure with locking plates or conservative without performing operations.
The pooled analysis of the included studies showed no significant difference between conservative treatment and operative treatment (MD = 0.39; 95% CI:[-0.15, 0.94]; P = 0.425). The pooled studies were heterogeneous (I2 = 83%).
Four studies reported postoperative complications either after the operative procedure or conservative without performing operations.
The pooled analysis of the included studies showed no significant difference between conservative treatment and operative treatment (RR = 1.148; 95% CI:[0.369 3.575]; P = 0.507). The pooled studies were homogeneous and no heterogeneity (I2 = 0%) was detected between the included studies.
Four studies reported the outcome of non-union rate either after the operative procedure or conservative without performing operations. The pooled analysis of the included studies showed no significant difference between conservative treatment and operative treatment (RR = 0.85; 95% CI:[0.72 – 2.28]; P = 0.158). The pooled studies were homogeneous and no heterogeneity (I2 = 0%) was detected between the included studies.
Findings of the included studies were reported as the following:
Locked plate fixation had a higher complication rate in Sanders et al. (2011) study, requiring more additional treatment for a proximal humeral fracture, which was often related to the initial surgery. Improving surgical techniques could lead to better outcomes for surgically treated patients.
The results of Olerud et al. (2011) study indicate an advantage in functional outcome and HRQoL in favor of the locking plate compared to non-operative treatment in elderly patients with a displaced 3-part fracture of the proximal humerus, but at the cost of additional surgery in 30% of the patients.
Fjalestad et al. (2012) reported that despite good results for locked plating on short-term follow-up, this study shows that patients treated non-surgically for a proximal humeral fracture achieve better ROM on midterm follow-up (>1 year) compared with patients treated with a locking plate. The results indicate that nonsurgical treatment should have a more prominent role in the treatment of proximal humeral fractures, even in cases that present clear indications for locking plate treatment.
The outcomes of locked plate fixation in Okike et al. (2015) study were similar to those of non-operative treatment for a proximal humeral fracture. In addition, rates of complications and secondary surgical procedures were higher for operative patients than for non-operative patients.
With insufficient functional results and high complication rates in Locked plate fixation in Çaliskan and doğan (2019) study, non-operative management is still the preferred choice for proximal humerus fractures, especially in the case of multipart fractures.
Surgical treatment with a locked plate proved no better results than conservative treatment for patients with a displaced proximal humeral fracture at a 2-year follow-up in Fjalestad and Hole (2014) study.
LaunonenI et al. (2019) reported no significant difference in clinical outcomes at 2 years between surgery with a locked plate and non-operative treatment in patients 60 years of age or older with displaced fractures of the proximal humerus.
Finally, more prospective multi-centered studies on large scales are required to compare between functional outcomes of locking plates and non-operative treatment in elderly patients as well as other populations.