Immobilization Period for Non-Operative Treatment of Proximal Humerus Fracture: Systematic Review and Meta-analysis

Abstract

Abstract Purpose Proximal humerus fractures (PHFs) are common fractures in the elderly and are typically treated conservatively with immobilization. However, there is no consensus on whether to choose early or conventional late mobilization and their outcomes into account. This paper reviews comparative studies on the one and three weeks’ immobilization period clinical outcomes in terms of 1) limb function, 2) pain intensity, and 3) complications, following the adoption of the PHF non-surgical treatment. Method Current systematic review searches PubMed, Scopus, and Web of science databases, looking for randomized clinical trials on patients with PHF, comparing clinical outcomes between two groups who immobilized for one week (early mobilization) or three weeks (late mobilization). We also performed a meta-analysis to compare the two groups' limb function and pain levels at three and six months of follow-up. Result Five of the seven RCTs had adequate data to be included in the meta-analysis. The quantitative results show that early mobilized patients have improved limb function at three (std mean difference: 0.42, CI 95%: 0.137–0.707) and six (std mean difference: 0.37, CI 95%: 0.098–0.644) months’ follow-up. At either three or six months, there was no difference in pain intensity between the two groups. Conclusion This review supports adoption of early mobilization at one week for PHFs non-operative management. However, to compare the long-term effects, more clinical trials with longer follow-ups are beneficial. Level of Evidence: level I (systematic review and meta-analysis)