Challoumas Dimitris, Minhas Haroon, Bagni Stephanie, Millar Neal
School of Infection and Immunity, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
BMC Musculoskelet Disord. 2025 Feb 27;26(1):203. doi: 10.1186/s12891-025-08371-y.
Proximal humerus fractures (PHFs) are among the commonest bony injuries and the majority of them can be managed non-surgically. The aim of our systematic review and meta-analysis was to compare the effectiveness and safety of early versus delayed mobilisation in conservatively treated PHFs.
A literature search was performed in Medline, EMBASE and clinicaltrials.gov in Januray 2025 aiming to identify all randomised controlled trials (RCTs) comparing early versus delayed (conventional) mobilisation as part of the non-surgical management of PHFs. Primary outcomes were patient-reported function and pain at short-term (3 months), mid-term (6 months) and long-term (12 months) follow-up, and secondary outcomes included secondary fracture displacement and total complications. Meta-analyses produced mean differences (MDs) or standardised MDs (SMDs) for continuous outcomes and odds ratios (ORs) for binary outcomes, with 95% confidence intervals (CI). Certainty of evidence was assessed using the GRADE tool. Recommendations for clinical practice were given only based on results of high or moderate certainty of evidence.
Six (6) RCTs were included that compared early mobilisation (EM; within one week from injury) to delayed mobilisation (DM; after 3 or 4 weeks of immobilisation) with a total of 470 patients with PHFs. There were no differences in patient-reported function (combined or Constant score) or pain between the EM and DM groups at any follow-up time points except for a significant difference in combined function scores favouring EM [SMD 0.4 CI (0.1,0.7), P = 0.006] at 3 months follow-up. There were no significant differences in the incidence of secondary fracture displacement and total complications in the two groups [OR 3.5 CI (0.7,18.2), P > 0.05, and OR 1.2 CI (0.5,2.9), P > 0.05, respectively]. All results were based on moderate or high strength of evidence. The most significant limitations of our study were the small number of pooled studies and inability to perform subgroup analyses for specific fracture types.
Our meta-analysis of RCTs showed that commencement of mobilisation within one week from injury for non-surgically managed PHFs is safe and may confer short-term functional benefits compared to delayed mobilisation.
肱骨近端骨折（PHFs）是最常见的骨损伤之一，大多数此类骨折可采用非手术治疗。我们进行系统评价和荟萃分析的目的是比较保守治疗的肱骨近端骨折早期与延迟活动的有效性和安全性。
2025年1月在Medline、EMBASE和clinicaltrials.gov进行文献检索，旨在识别所有比较早期与延迟（传统）活动作为肱骨近端骨折非手术治疗一部分的随机对照试验（RCTs）。主要结局是患者报告的短期（3个月）、中期（6个月）和长期（12个月）随访时的功能和疼痛，次要结局包括二次骨折移位和总并发症。荟萃分析得出连续结局的平均差（MDs）或标准化平均差（SMDs）以及二分类结局的比值比（ORs），并给出95%置信区间（CI）。使用GRADE工具评估证据的确定性。仅根据高确定性或中等确定性证据的结果给出临床实践建议。
纳入了6项随机对照试验，比较了早期活动（EM；受伤后1周内）与延迟活动（DM；固定3或4周后），共有470例肱骨近端骨折患者。除了在3个月随访时联合功能评分有利于早期活动有显著差异[标准化平均差0.4，置信区间（0.1,0.7），P = 0.006]外，在任何随访时间点，早期活动组和延迟活动组之间患者报告的功能（联合或Constant评分）或疼痛均无差异。两组二次骨折移位和总并发症的发生率无显著差异[比值比3.5，置信区间（0.7,18.2），P > 0.05，以及比值比1.2，置信区间（0.5,2.9），P > 0.05]。所有结果均基于中等或高强度证据。我们研究最显著的局限性是纳入研究数量少，且无法对特定骨折类型进行亚组分析。
我们对随机对照试验的荟萃分析表明，对于非手术治疗的肱骨近端骨折，受伤后1周内开始活动是安全的，与延迟活动相比可能带来短期功能益处。
