Table 3. Certainty of evidence for surgical treatment options of proximal humerus fractures in the elderly.
N/A = Not Applicable.
| Intervention | Outcome (measure) | Comparator (C) | NRCT+Cohort/Trials [Reference(s)] | Results | Certainty of evidence (GRADE) | Comment |
|---|---|---|---|---|---|---|
| Surgical vs. surgical methods—proximal humerus fractures | ||||||
| Plates with monoaxial locking screws | Function | Plates with polyaxial locking screws | 56+76/1 RCT and 1 cohorts/ [65, 66] | - | (⊕❍❍❍) | N/A |
| Plates with monoaxial locking screws | Quality of life | Plates with polyaxial locking screws | - | - | (⊕❍❍❍) | No study |
| Plates with monoaxial locking screws | Complications | Plates with polyaxial locking screws | 56+76/1 RCT and 1 cohorts/ [65, 66] | - | (⊕❍❍❍) | N/A |
| Plates with enhanced support | Function | Plates without enhanced support | 122/ 2 RCTs/ [53, 67] | - | (⊕❍❍❍) | N/A |
| Plates with enhanced support | Quality of life | Plates without enhanced support | - | - | (⊕❍❍❍) | No study |
| Plates with enhanced support | Complications | Plates without enhanced support | 122/ 2 RCTs + 1 cohort/ [53, 67, 68] | - | (⊕❍❍❍) | N/A |
| Different kinds of internal fixation | Function | Prosthesis | 60+104 /1 RCT and 2 cohorts/[54, 69, 70] | - | (⊕❍❍❍) | |
| Different kinds of internal fixation | Quality of life | Prosthesis | 44/ 1 cohort/[69] | - | (⊕❍❍❍) | |
| Different kinds of internal fixation | Complications | Prosthesis | 60+104 /1 RCT and 2 cohorts/[54, 69, 70] | - | (⊕❍❍❍) | |
| Plate fixation | Function | Intramedullary nail | 65+193/1 RCT and 2 cohorts/[71–73] | No clinically important difference MDRCT, -3.8 (95% CI: -11.85 to 4.25) MDcohorts: 4.51 (95% CI: -0.99 to 10.1) | (⊕⊕❍❍) | Single study |
| Plate fixation | Quality of life | Intramedullary nail | 41/1 cohort/[73] | - | (⊕❍❍❍) | Single study |
| Plate fixation | Complications | Intramedullary nail | 65+328/1 RCT and 3 cohorts/[71–74] | - | (⊕❍❍❍) | -1 indirectness |
| -2 inconsistency | ||||||
| Reverse shoulder arthroplasty (RSA) | Function | Hemiarthroplasty (HA) | 61+448/1 RCT and 3 cohort/[61–64] | Statistically significant difference RSA>HA | (⊕⊕❍❍) | -1 risk of bias |
| MDRCT 6.9 (95% CI: 3.0 to 10.8) | -1 indirectness | |||||
| Reverse shoulder arthroplasty (RSA) | Quality of life | Hemiarthroplasty (HA) | - | - | (⊕❍❍❍) | No study |
| Reverse shoulder arthroplasty (RSA) | ComplicationsMinor and major | Hemiarthroplasty (HA) | Minor: 62+80/1 RCT and 2 cohorts /[61–63] Major: 368/ 1 cohort/[64] | - | (⊕❍❍❍) | -2 indirectness-1 inconsistency |
| Different kinds of fixation of the tubercles during arthroplasty | Function | Different kinds of fixation of the tubercles during arthroplasty | 35+54/1 RCT and 1 cohort/[75, 76] | - | (⊕❍❍❍) | -1 risk of bias |
| -1 indirectness -1 inconsistency | ||||||
| Different kinds of fixation of the tubercles during arthroplasty | Quality of life | Different kinds of fixation of the tubercles during arthroplasty | - | - | (⊕❍❍❍) | No study |
| Different kinds of fixation of the tubercles during arthroplasty | Complications | Different kinds of fixation of the tubercles during arthroplasty | 35/1 RCT/[75] | - | (⊕❍❍❍) | Single study |
| Straight intramedullary nail | Function | Curved intramedullary nail | 52/1 RCT/[77] | - | (⊕❍❍❍) | Single study |
| Straight intramedullary nail | Quality of life | Curved intramedullary nail | - | - | (⊕❍❍❍) | No study |
| Straight intramedullary nail | Complications | Curved intramedullary nail | 52/1 RCT/[77] | - | (⊕❍❍❍) | Single study |