Surgical management of complex proximal humerus fractures-a systematic review of 92 studies including 4500 patients.

Abstract

OBJECTIVES:

To compare the outcomes of open reduction and internal fixation (ORIF), closed reduction and percutaneous pinning, hemiarthroplasty (HA), and reverse shoulder arthroplasty (RSA) for proximal humerus fractures.

DATA SOURCES:

The search was performed on September 9, 2012 using an explicit search algorithm in the following databases: Medline, SportDiscus, CINAHL, and Cochrane Central Register of Controlled Trials. Inclusion criteria were English language studies reporting clinical outcomes after surgical treatment of 3- or 4-part proximal humerus fractures with a minimum of 1-year follow-up.

STUDY SELECTION:

English language studies reporting clinical outcomes after surgical treatment of 3- or 4-part proximal humerus fractures with a minimum of 1-year follow-up. Levels 1-4 studies were eligible for inclusion.

DATA EXTRACTION:

Study methodological quality and bias was evaluated using the Modified Coleman Methodology Score.

DATA SYNTHESIS:

Two-proportion Z test and multivariate linear regression analyses were used for group comparisons.

CONCLUSIONS:

Significantly better clinical outcomes were observed for ORIF over HA and RSA (American Shoulder and Elbow Score, Disabilities of Arm, Shoulder, and Hand, Constant) (P < 0.05). However, ORIF had a significantly higher reoperation rate versus HA and RSA (P < 0.001 for both). Comparing HA with RSA, there was no difference in any outcome measure. The rate of tuberosity nonunion was 15.4% in the HA group. There were more complications following closed reduction and percutaneous pinning versus ORIF, HA, and RSA (P < 0.05). ORIF for proximal humerus fractures demonstrates better clinical outcome scores but with a significantly higher reoperation rate. HA and RSA are effective as well, but tuberosity nonunion remains a concern with HA.

• Authors: Anil K Gupta, Joshua D Harris, Brandon J Erickson, Geoffrey D Abrams, Benjamin Bruce, Frank McCormick, Gregory P Nicholson, Anthony A Romeo
• Journal: Journal of orthopaedic trauma (J Orthop Trauma) Vol. 29 Issue 1 Pg. 54-9 (Jan 2015) ISSN: 1531-2291 [Electronic] United States
• PMID: 25162974 (Publication Type: Comparative Study, Journal Article, Review, Systematic Review)

Topics

• Arthroplasty, Replacement
• Fracture Fixation
• Hemiarthroplasty
• Humans
• Shoulder Fractures (surgery)