Surgical and Non‐Surgical Treatment for 3‐Part and 4‐Part Fractures of the Proximal Humerus: A Systematic Review of Overlapping Meta‐Analyses

This systematic review of overlapping meta‐analyses was conducted to propose a principle to make decisions for comparing clinical safety and efficacy of surgical and non‐surgical treatment for displaced 3‐part and 4‐part fractures of the proximal humerus. Three electronic databases (PubMed, EMBASE, and the Cochrane Library) were systematically searched to retrieve available published systematic reviews and meta‐analyses comparing surgical versus non‐surgical treatment for displaced 3‐part and 4‐part fractures of the proximal humerus. Ten meta‐analyses were identified for this investigation. Based on the application of selection with the Jadad algorithm, a meta‐analysis including 6 randomized clinical trials was selected for this systematic review, which demonstrated the best available evidence that no statistically significant differences were found in the Constant score, health‐related quality of life, and mortality between surgical and non‐surgical treatments for displaced 3‐part and 4‐part fractures of the proximal humerus; however, surgical treatment was associated with a significant increase in the incidence of reoperation. This systematic review of overlapping meta‐analyses reveals that although surgical treatment is more advantageous than and superior to non‐surgical treatment for displaced 3‐part and 4‐part fractures of the proximal humerus, the former leads to a higher incidence of postoperative complications.