Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Mar 2019
Meta AnalysisTuberosity healing after reverse shoulder arthroplasty for complex proximal humeral fractures in elderly patients-does it improve outcomes? A systematic review and meta-analysis.
Reverse shoulder arthroplasty (RSA) is being increasingly used for complex, displaced fractures of the proximal humerus in older patients. Anatomic tuberosity healing in RSA has been recognized to restore better shoulder function. We compared the reported clinical and functional outcomes of RSA in proximal humeral fractures with and without tuberosity healing. ⋯ The RSA group with healed greater tuberosity showed better range of motion, especially forward flexion and external rotation and Constant scores, compared with the nonhealed greater tuberosity group. Tuberosity healing may influence overall shoulder function after RSA for proximal humeral fractures in the elderly, and this needs verification with future prospective studies.
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J Shoulder Elbow Surg · Aug 2018
Review Meta AnalysisOperative versus nonoperative treatment of proximal humeral fractures: a systematic review, meta-analysis, and comparison of observational studies and randomized controlled trials.
There is no consensus on the choice of treatment for displaced proximal humeral fractures in older patients (aged > 65 years). The aims of this systematic review and meta-analysis were (1) to compare operative with nonoperative management of displaced proximal humeral fractures and (2) to compare effect estimates obtained from randomized controlled trials (RCTs) and observational studies. ⋯ We recommend nonoperative treatment for the average elderly patient (aged > 65 years) with a displaced proximal humeral fracture. Pooled effects of observational studies were similar to those of RCTs, and including observational studies led to more generalizable conclusions.
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J Shoulder Elbow Surg · Mar 2018
Review Meta AnalysisOperative versus nonoperative treatment for the management of full-thickness rotator cuff tears: a systematic review and meta-analysis.
Rotator cuff disease is the most common pathology of the shoulder, responsible for approximately 70% of clinic visits for shoulder pain. However, no consensus exists on the optimal treatment. The aim of this study was to analyze level I and II research comparing operative versus nonoperative management of full-thickness rotator cuff tears. ⋯ There was a statistically significant improvement in outcomes for patients managed operatively compared with those managed nonoperatively. The differences in both Constant and VAS scores were small and did not meet the minimal difference considered clinically significant. Larger studies with longer follow-up are required to determine whether clinical differences between these treatments become evident over time.
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J Shoulder Elbow Surg · Feb 2018
Review Meta AnalysisOpen reduction-internal fixation versus intramedullary nailing for humeral shaft fractures: an expected value decision analysis.
Previous randomized controlled studies and meta-analyses have failed to collectively favor either open reduction-internal fixation (ORIF) or intramedullary nailing (IMN) fixation. The purpose of our investigation was to elucidate the optimal decision between ORIF and IMN for acute traumatic operative humeral shaft fractures through an expected value decision analysis. ⋯ Our expected value decision analysis demonstrates that patients favor ORIF over IMN as the optimal treatment decision for an acute traumatic humeral shaft fracture.
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J Shoulder Elbow Surg · Sep 2017
Review Meta AnalysisDoes early motion lead to a higher failure rate or better outcomes after arthroscopic rotator cuff repair? A systematic review of overlapping meta-analyses.
The aims of the study were as follows: to perform a systematic review of meta-analyses comparing "early motion" and "delayed motion" after arthroscopic rotator cuff repair; to provide a framework to analyze the best available evidence to develop recommendations; and to identify gaps where suggestions could be made for future investigations. ⋯ The current highest level of evidence suggests that early-motion rehabilitation after rotator cuff repair results in superior postoperative range of motion up to 1 year. Whereas early motion and delayed motion after cuff repair may lead to comparable functional outcomes and retear rates, concern exists that early motion may result in greater retear rates, particularly with larger tear sizes.