Abstract
Background
There remains no consensus on the surgical treatment of complex proximal humeral fractures. In this meta-analysis, we pool available trials to compare the clinical outcomes of locking plate fixation and hemiarthroplasty for this injury.
Methods
A literature search between January 1990 and May 2012 in the main medical search engines (Pubmed, Medline, Embase search, and the Cochrane library) was included. We selected available trials that compared locking plate fixation and hemiarthroplasty in patients with complex proximal humeral fractures and that reported on functional outcomes, revisions, and method-related complications. The quality of the studies was assessed, and meta-analyses were performed with the Cochrane Collaboration’s REVMAN 5.0 software.
Results
A total of 567 patients from 9 trials were included in this meta-analysis (302 fractures treated with locking plate and 265 with hemiarthroplasty). In this comparison, we found that patients with locking plate fixation had better Constant–Murley score than with hemiarthroplasty, and hemiarthroplasty could reduce the rate of revisions and the method-related complications significantly.
Conclusions
Compared with hemiarthroplasty, patients with locking plate fixation could obtain more favorable functional outcomes, but technical detail was critical to minimize the risk of implant failure, avascular necrosis, and re-operation. As the possible significant bias and inconclusive evidence arising from the included trials, further randomized trials and observational studies should be recommended to support these finding.
Similar content being viewed by others
References
Court-Brown CM, Caesar B (2006) Epidemiology of adult fractures: a review. Injury 37(8):691–697. doi:10.1016/j.injury.2006.04.130
Lind T, Kroner K, Jensen J (1989) The epidemiology of fractures of the proximal humerus. Arch Orthop Trauma Surg 108(5):285–287
Neer CS 2nd (1970) Displaced proximal humeral fractures. II. Treatment of three-part and four-part displacement. J Bone Joint Surg Am 52(6):1090–1103
Neer CS 2nd (1970) Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am 52(6):1077–1089
Handoll HH, Ollivere BJ (2010) Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev 8(12):CD000434. doi:10.1002/14651858.CD000434.pub2
Court-Brown CM, McQueen MM (2007) Two-part fractures and fracture dislocations. Hand Clin 23(4):397–414. doi:10.1016/j.hcl.2007.08.003
Murray IR, Amin AK, White TO, Robinson CM (2011) Proximal humeral fractures: current concepts in classification, treatment and outcomes. J Bone Joint Surg Br 93(1):1–11. doi:10.1302/0301-620X.93B1.25702
Sudkamp N, Bayer J, Hepp P, Voigt C, Oestern H, Kaab M, Luo C, Plecko M, Wendt K, Kostler W, Konrad G (2009) Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Results of a prospective, multicenter, observational study. J Bone Joint Surg Am 91(6):1320–1328. doi:10.2106/JBJS.H.00006
Jobin CM, Galatz LM (2012) Proximal humerus fractures: pin, plate, or replace? Semin Arthroplasty 23(2):74–82
Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13. doi:10.1186/1471-2288-5-13
Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73(9):712–716
Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634
Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50(4):1088–1101
Dietrich M, Meier C, Lattmann T, Zingg U, Gruninger P, Platz A (2008) Complex fracture of the proximal humerus in the elderly. Locking plate osteosynthesis vs hemiarthroplasty. Chirurg 79(3):231–240. doi:10.1007/s00104-007-1436-z
Bastian JD, Hertel R (2009) Osteosynthesis and hemiarthroplasty of fractures of the proximal humerus: outcomes in a consecutive case series. J Should Elbow Surg 18(2):216–219. doi:10.1016/j.jse.2008.09.015
Solberg BD, Moon CN, Franco DP, Paiement GD (2009) Surgical treatment of three and four-part proximal humeral fractures. J Bone Joint Surg Am 91(7):1689–1697. doi:10.2106/JBJS.H.00133
Wang DL, Ruan DK, Yin Q, Li HF, Wang PJ, He Q (2009) Surgical treatment for complicated proximal humeral fractures and analysis of efficacy. Chin J Bone Joint Injury 24(11):985–987
Zhang J, Di Z, He Z, Feng J, Xu R (2010) Comparison of humeral head replacement and internal fixation for the treatment of 3 parts and 4 parts fractures of proximal humerus in the elderly]. China J Orthop Traumatol 23(6):435
Kim DS, Lee DK, Yi CH, Park JH, Rah JH (2011) Comparison of results between internal plate fixation and hemiarthroplasty in comminuted proximal humerus fracture. J Korean Fract Soc 24(2):144–150
Wild JR, DeMers A, French R, Shipps MR, Bergin PF, Musapatika D, Jelen BA (2011) Functional outcomes for surgically treated 3- and 4-part proximal humerus fractures. Orthopedics 34(10):e629–e633. doi:10.3928/01477447-20110826-14
Lu J, Zhou TM (2012) Comparative research of the outcomes after two different methods for treatment of four-part proximal humerus fractures. J Pract Orthop 18(2):115–117
Spross C, Platz A, Erschbamer M, Lattmann T, Dietrich M (2012) Surgical treatment of Neer group VI proximal humeral fractures: retrospective comparison of PHILOS((R)) and hemiarthroplasty. Clin Orthop Relat Res 470(7):2035–2042. doi:10.1007/s11999-011-2207-1
Zyto K, Wallace WA, Frostick SP, Preston BJ (1998) Outcome after hemiarthroplasty for three- and four-part fractures of the proximal humerus. J Should Elbow Surg 7(2):85–89
van de Water AT, Shields N, Taylor NF (2011) Outcome measures in the management of proximal humeral fractures: a systematic review of their use and psychometric properties. J Should Elbow Surg 20(2):333–343. doi:10.1016/j.jse.2010.10.028
Nijs S, Broos P (2009) Outcome of shoulder hemiarthroplasty in acute proximal humeral fractures: a frustrating meta-analysis experience. Acta Orthop Belg 75(4):445–451
Misra A, Kapur R, Maffulli N (2001) Complex proximal humeral fractures in adults—a systematic review of management. Injury 32(5):363–372
Lanting B, MacDermid J, Drosdowech D, Faber KJ (2008) Proximal humeral fractures: a systematic review of treatment modalities. J Should Elbow Surg 17(1):42–54. doi:10.1016/j.jse.2007.03.016
Schliemann B, Siemoneit J, Theisen C, Kosters C, Weimann A, Raschke MJ (2012) Complex fractures of the proximal humerus in the elderly-outcome and complications after locking plate fixation. Musculoskelet Surg 96(Suppl 1):S3–S11. doi:10.1007/s12306-012-0181-8
Brorson S, Frich LH, Winther A, Hrobjartsson A (2011) Locking plate osteosynthesis in displaced 4-part fractures of the proximal humerus. Acta Orthop 82(4):475–481. doi:10.3109/17453674.2011.588856
Brunner F, Sommer C, Bahrs C, Heuwinkel R, Hafner C, Rillmann P, Kohut G, Ekelund A, Muller M, Audige L, Babst R (2009) Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate: a prospective multicenter analysis. J Orthop Trauma 23(3):163–172. doi:10.1097/BOT.0b013e3181920e5b
Krappinger D, Bizzotto N, Riedmann S, Kammerlander C, Hengg C, Kralinger FS (2011) Predicting failure after surgical fixation of proximal humerus fractures. Injury 42(11):1283–1288. doi:10.1016/j.injury.2011.01.017
Hente R, Kampshoff J, Kinner B, Fuchtmeier B, Nerlich M (2004) Treatment of dislocated 3- and 4-part fractures of the proximal humerus with an angle-stabilizing fixation plate. Unfallchirurg 107(9):769–782. doi:10.1007/s00113-004-0818-7
Helwig P, Bahrs C, Epple B, Oehm J, Eingartner C, Weise K (2009) Does fixed-angle plate osteosynthesis solve the problems of a fractured proximal humerus? A prospective series of 87 patients. Acta Orthop 80(1):92–96
Thanasas C, Kontakis G, Angoules A, Limb D, Giannoudis P (2009) Treatment of proximal humerus fractures with locking plates: a systematic review. J Should Elbow Surg 18(6):837–844. doi:10.1016/j.jse.2009.06.004
Boileau P, Pennington SD, Alami G (2011) Proximal humeral fractures in younger patients: fixation techniques and arthroplasty. J Should Elbow Surg 20(2 Suppl):S47–S60. doi:10.1016/j.jse.2010.12.006
Fialka C, Stampfl P, Arbes S, Reuter P, Oberleitner G, Vecsei V (2008) Primary hemiarthroplasty in four-part fractures of the proximal humerus: randomized trial of two different implant systems. J Should Elbow Surg 17(2):210–215. doi:10.1016/j.jse.2007.07.002
Kralinger F, Schwaiger R, Wambacher M, Farrell E, Menth-Chiari W, Lajtai G, Hubner C, Resch H (2004) Outcome after primary hemiarthroplasty for fracture of the head of the humerus. A retrospective multicentre study of 167 patients. J Bone Joint Surg Br 86(2):217–219
Greiner SH, Diederichs G, Kroning I, Scheibel M, Perka C (2009) Tuberosity position correlates with fatty infiltration of the rotator cuff after hemiarthroplasty for proximal humeral fractures. J Should Elbow Surg 18(3):431–436. doi:10.1016/j.jse.2008.10.007
Boileau P, Krishnan SG, Tinsi L, Walch G, Coste JS, Mole D (2002) Tuberosity malposition and migration: reasons for poor outcomes after hemiarthroplasty for displaced fractures of the proximal humerus. J Should Elbow Surg 11(5):401–412
Mighell MA, Kolm GP, Collinge CA, Frankle MA (2003) Outcomes of hemiarthroplasty for fractures of the proximal humerus. J Should Elbow Surg 12(6):569–577
Sirveaux F, Roche O, Mole D (2010) Shoulder arthroplasty for acute proximal humerus fracture. Orthop Traumatol Surg Res 96(6):683–694. doi:10.1016/j.otsr.2010.07.001
DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7(3):177–188
Deeks JJ, Dinnes J, D’Amico R, Sowden AJ, Sakarovitch C, Song F, Petticrew M, Altman DG (2003) Evaluating non-randomised intervention studies. Health Technol Assess 7(27):iii–x, 1–173
Simillis C, Constantinides VA, Tekkis PP, Darzi A, Lovegrove R, Jiao L, Antoniou A (2007) Laparoscopic versus open hepatic resections for benign and malignant neoplasms—a meta-analysis. Surgery 141(2):203–211. doi:10.1016/j.surg.2006.06.035
Conflict of interest
There are no disclosures or conflicts of interest for either author.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Dai, J., Chai, Y., Wang, C. et al. Meta-analysis comparing locking plate fixation with hemiarthroplasty for complex proximal humeral fractures. Eur J Orthop Surg Traumatol 24, 305–313 (2014). https://doi.org/10.1007/s00590-013-1179-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00590-013-1179-0