Results for incidence of additional surgery, from network meta-analysis (lower diagonal part) and pairwise meta-analysis (upper diagonal part).

<p>Results for incidence of additional surgery, from network meta-analysis (lower diagonal part) and pairwise meta-analysis (upper diagonal part).</p

Effectiveness and Safety of Interventions for Treating Adults with Displaced Proximal Humeral Fracture: A Network Meta-Analysis and Systematic Review

<div><p>Purpose</p><p>Network meta-analysis (NMA) is a comparatively new evidence-based technique in medical disciplines which compares the relative benefits associated with multiple interventions and obtains hierarchies of these interventions for various treatment options. We evaluated the effectiveness and safety of open reduction and internal fixation (ORIF), hemiarthroplasty (HA), reverse shoulder arthroplasty (RSA), intramedullary nailing (IN) and non-operative treatment (NOT) of displaced proximal humeral fractures in adults using Bayesian NMA of data from clinical trials.</p><p>Method</p><p>PUBMED, EMBASE and CENTRAL in July 2016 were searched and clinical trials that evaluated interventions for treating adults with displaced proximal humeral fractures were identified. Methodological qualities of studies were assessed by the Newcastle—Ottawa Scale and risk of bias using the Cochrane Collaboration tool.</p><p>Result</p><p>Thirty-four trials involving 2165 participants were included in the study. RSA had significantly the highest Constant score and lower total incidence of complications than ORIF, HA and IN. Moreover, RSA resulted in a lower incidence of additional surgery than ORIF and IN. The rank of treatments in terms high Constant score was: RSA, ORIF, IN, NOT and HA. The rank for reduction in total incidence of complications was: RSA, NOT, HA, IN and ORIF. For lowering the risk of additional surgery, the rank was: RSA, NOT, HA, IN and ORIF.</p><p>Conclusion</p><p>RSA had the highest probability for improving functional outcome and reduction in the total incidence of complications and requiring additional surgery among the five interventions for treating adults with displaced proximal humeral fracture.</p></div

Network of treatment comparisons for incidence of total complications.

<p>The size of the node corresponds to the total sample size of treatments. Directly comparable treatments are linked with a line, the thickness of which represents the number of trials that were compared. ORIF: open reduction and internal fixation; HA: hemiarthroplasty; RSA: reverse shoulder arthroplasty; IN: intramedullary nailing; NOT: Non-operative treatment.</p

Ranking of treatment strategies based on the probability of their effects on the outcome of incidence of total complications.

<p>ORIF: open reduction and internal fixation; HA: hemiarthroplasty; RSA: reverse shoulder arthroplasty; IN: intramedullary nailing; NOT: Non-operative treatment.</p

Results for total complications, from network meta-analysis (lower diagonal part) and pairwise meta-analysis (upper diagonal part).

<p>Results for total complications, from network meta-analysis (lower diagonal part) and pairwise meta-analysis (upper diagonal part).</p

Flow chart of selection of studies for inclusion in meta- analysis.

<p><i>From</i>: Moher D, Liberati A, TetZlaff J, Altman DG, The PRISMA Group (2009). <i>P</i>referred <i>R</i>eporting <i>I</i>tems for <i>S</i>ystematic Reviews and <i>M</i>eta-<i>A</i>nalyses: The PRISMA Statement. PLoS Med 6(7): e1000097. doi: <a href="http://dx.doi.org/10.1371/journal.pmed1000097" target="_blank">10.1371/journal.pmed1000097</a><b>For more information, visit</b><a href="http://www.prisma-statement.org" target="_blank">www.prisma-statement.org</a>.</p

Quality assessment of case—control studies comparing different treatments for displaced proximal humeral fracture using Newcastle—Ottawa Scale.

<p>Quality assessment of case—control studies comparing different treatments for displaced proximal humeral fracture using Newcastle—Ottawa Scale.</p

Network of treatment comparisons for constant score.

<p>The size of the node corresponds to the total sample size of treatments. Directly comparable treatments are linked with a line, the thickness of which represents the number of trials that were compared. ORIF: open reduction and internal fixation; HA: hemiarthroplasty; RSA: reverse shoulder arthroplasty; IN: intramedullary nailing; NOT: Non-operative treatment.</p

Results for constant score, from network meta-analysis (lower diagonal part) and pairwise meta-analysis (upper diagonal part).

<p>Results for constant score, from network meta-analysis (lower diagonal part) and pairwise meta-analysis (upper diagonal part).</p

Ranking of treatment strategies based on the probability of their effects on the outcome of incidence of additional surgery.

<p>ORIF: open reduction and internal fixation; HA: hemiarthroplasty; RSA: reverse shoulder arthroplasty; IN: intramedullary nailing; NOT: Non-operative treatment.</p