Top

BMC Musculoskeletal Disorders

Published in:

Open Access 01-12-2024 | Systematic Review

Cement-augmented locked plate fixation proximal humerus fractures in elderly patient: a systematic review and meta-analysis

Authors: Dong-Yang Li, Kun Zhang

Published in: BMC Musculoskeletal Disorders | Issue 1/2024

Abstract

Background

This systemic review and meta-analysis aimed to evaluate the clinical outcomes of proximal humeral fracture in elderly patient fixation using locked plate with or without cement augmentation.

Methods

The databases of PubMed, Embase, and Cochrane Library were searched in August 2023 for literature comparing the clinical outcomes of patients with PHFs treated with locked plate alone and locked plate augmented with cement. Data describing study design; level of evidence; inclusion criteria; demographic information; final follow-up; revision rate; implant failure rate; avascular necrosis rate; total complication rate; constant score; and disability of arm, shoulder, and hand (DASH) score were collected.

Results

Eight studies (one randomized-controlled trial and seven observational studies), involving 664 patients, were identified. Compared with locked plates alone, using cement-augmented locked plates reduced the implant failure rate (odds ratio (OR) = 0.19; 95% confidence interval (CI) 0.10–0.39; P < 0.0001) and total complication rate (OR = 0.45; 95% CI 0.29–0.69; P = 0.0002) and improved DASH scores (mean difference (MD) = 2.99; 95% CI 1.00–4.98; P = 0.003). However, there was no significant difference in clinical outcomes, including revision rate, avascular necrosis rate, and constant score.

Conclusion

In this review and meta-analysis, fixation of the PHFs in elderly patients using locked plates with or without cement augmentation has no significant difference in revision rate, but the implant failure and total complication rates may be lesser on using the cement-augmented locked plate for fixation than on using a locked plate alone. Good results are expected for most patients treated with this technique.

Trial registration

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)21 guidelines were followed to conduct this systematic review and meta-analysis and was registered as a protocol in PROSPERO (CRD42022318798).

Available only for authorised users

Launonen AP, Lepola V, Saranko A, Flinkkilä T, Laitinen M, Mattila VM. Epidemiology of proximal humerus fractures. Archives Osteoporos. 2015;10:209.CrossRef

Saltzman BM, Erickson BJ, Harris JD, Gupta AK, Mighell M, Romeo AA. Fibular Strut Graft Augmentation for Open reduction and internal fixation of proximal Humerus fractures: a systematic review and the authors’ Preferred Surgical technique. Orthop J Sports Med. 2016;4(7):2325967116656829.PubMedPubMedCentral

Bergdahl C, Ekholm C, Wennergren D, Nilsson F, Möller M. Epidemiology and patho-anatomical pattern of 2,011 humeral fractures: data from the Swedish fracture Register. BMC Musculoskelet Disord. 2016;17:159.CrossRefPubMedPubMedCentral

Schumaier A, Grawe B. Proximal Humerus fractures: evaluation and management in the Elderly patient. Geriatric Orthop Surg Rehabilitation. 2018;9:2151458517750516.CrossRef

Lander ST, Mahmood B, Maceroli MA, et al. Mortality rates of Humerus fractures in the Elderly: does Surgical Treatment Matter? J Orthop Trauma. 2019;33(7):361–5.CrossRefPubMedPubMedCentral

Tepass A, Blumenstock G, Weise K, Rolauffs B, Bahrs C. Current strategies for the treatment of proximal humeral fractures: an analysis of a survey carried out at 348 hospitals in Germany, Austria, and Switzerland. J Shoulder Elbow Surg. 2013;22(1):e8–14.CrossRefPubMed

Erasmo R, Guerra G, Guerra L. Fractures and fracture-dislocations of the proximal humerus: a retrospective analysis of 82 cases treated with the Philos(®) locking plate. Injury. 2014;45(Suppl 6):S43–8.CrossRefPubMed

Konrad G, Hirschmüller A, Audige L, Lambert S, Hertel R, Südkamp NP. Comparison of two different locking plates for two-, three- and four-part proximal humeral fractures–results of an international multicentre study. Int Orthop. 2012;36(5):1051–8.CrossRefPubMed

Sproul RC, Iyengar JJ, Devcic Z, Feeley BT. A systematic review of locking plate fixation of proximal humerus fractures. Injury. 2011;42(4):408–13.CrossRefPubMed

10.

Südkamp N, Bayer J, Hepp P, et al. 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 Volume. 2009;91(6):1320–8.CrossRef

11.

Clavert P, Adam P, Bevort A, Bonnomet F, Kempf JF. Pitfalls and complications with locking plate for proximal humerus fracture. J Shoulder Elbow Surg. 2010;19(4):489–94.CrossRefPubMed

12.

Brunner F, Sommer C, Bahrs C, et al. Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate: a prospective multicenter analysis. J Orthop Trauma. 2009;23(3):163–72.CrossRefPubMed

13.

Königshausen M, Kübler L, Godry H, Citak M, Schildhauer TA, Seybold D. Clinical outcome and complications using a polyaxial locking plate in the treatment of displaced proximal humerus fractures. Reliable System? Injury. 2012;43(2):223–31.CrossRefPubMed

14.

Krappinger D, Bizzotto N, Riedmann S, Kammerlander C, Hengg C, Kralinger FS. Predicting failure after surgical fixation of proximal humerus fractures. Injury. 2011;42(11):1283–8.CrossRefPubMed

15.

Krappinger D, Roth T, Gschwentner M, et al. Preoperative assessment of the cancellous bone mineral density of the proximal humerus using CT data. Skeletal Radiol. 2012;41(3):299–304.CrossRefPubMed

16.

Lill H, Hepp P, Korner J, et al. Proximal humeral fractures: how stiff should an implant be? A comparative mechanical study with new implants in human specimens. Arch Orthop Trauma Surg. 2003;123(2–3):74–81.CrossRefPubMed

17.

Röderer G, Scola A, Schmölz W, Gebhard F, Windolf M, Hofmann-Fliri L. Biomechanical in vitro assessment of screw augmentation in locked plating of proximal humerus fractures. Injury. 2013;44(10):1327–32.CrossRefPubMed

18.

Schliemann B, Seifert R, Rosslenbroich SB, et al. Screw augmentation reduces motion at the bone-implant interface: a biomechanical study of locking plate fixation of proximal humeral fractures. J Shoulder Elbow Surg. 2015;24(12):1968–73.CrossRefPubMed

19.

Marongiu G, Verona M, Cardoni G, Capone A. Synthetic bone substitutes and mechanical devices for the Augmentation of Osteoporotic Proximal Humeral fractures: a systematic review of Clinical studies. J Funct Biomaterials 2020; 11(2).

20.

Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg. 2003;73(9):712–6.CrossRefPubMed

21.

Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ (Clinical Res ed). 2003;327(7414):557–60.CrossRef

22.

Foruria AM, Martinez-Catalan N, Valencia M, Morcillo D, Calvo E. Proximal humeral fracture locking plate fixation with anatomic reduction, and a short-and-cemented-screws configuration, dramatically reduces the implant related failure rate in elderly patients. JSES Int. 2021;5(6):992–1000.CrossRefPubMedPubMedCentral

23.

Hakimi SA, Schumacher K, Ring A. Angle-stable polyaxial locked plating with and without polymethylmethacrylate cement augmentation for proximal humeral fractures in elderly. Joint Dis Relat Surg. 2021;32(3):575–82.CrossRef

24.

Siebenbürger G, Helfen T, Biermann N, Haasters F, Böcker W, Ockert B. Screw-tip augmentation versus standard locked plating of displaced proximal humeral fractures: a retrospective comparative cohort study. J Shoulder Elbow Surg. 2019;28(7):1326–33.CrossRefPubMed

25.

Katthagen JC, Lutz O, Voigt C, Lill H, Ellwein A. Cement augmentation of humeral head screws reduces early implant-related complications after locked plating of proximal humeral fractures. Obere Extremitat. 2018;13(2):123–9.CrossRefPubMedPubMedCentral

26.

Hengg C, Nijs S, Klopfer T, et al. Cement augmentation of the proximal humerus internal locking system in elderly patients: a multicenter randomized controlled trial. Arch Orthop Trauma Surg. 2019;139(7):927–42.CrossRefPubMedPubMedCentral

27.

Egol KA, Sugi MT, Ong CC, Montero N, Davidovitch R, Zuckerman JD. Fracture site augmentation with calcium phosphate cement reduces screw penetration after open reduction-internal fixation of proximal humeral fractures. J Shoulder Elbow Surg. 2012;21(6):741–8.CrossRefPubMed

28.

Lee CW, Shin SJ. Prognostic factors for unstable proximal humeral fractures treated with locking-plate fixation. J Shoulder Elbow Surg. 2009;18(1):83–8.CrossRefPubMed

29.

Liu ZZ, Zhang GM, Ge T. Use of a proximal humeral internal locking system enhanced by injectable graft for minimally invasive treatment of osteoporotic proximal humeral fractures in elderly patients. Orthop Surg. 2011;3(4):253–8.CrossRefPubMedPubMedCentral

30.

Dasari SP, Kerzner B, Fortier LM, et al. Improved outcomes for proximal humerus fracture open reduction internal fixation augmented with a fibular allograft in elderly patients: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2022;31(4):884–94.CrossRefPubMed

31.

Barlow JD, Logli AL, Steinmann SP, et al. Locking plate fixation of proximal humerus fractures in patients older than 60 years continues to be associated with a high complication rate. J Shoulder Elbow Surg. 2020;29(8):1689–94.CrossRefPubMed

32.

Owsley KC, Gorczyca JT. Fracture displacement and screw cutout after open reduction and locked plate fixation of proximal humeral fractures [corrected]. J bone Joint Surg Am Volume. 2008;90(2):233–40.CrossRef

33.

Hirschmann MT, Quarz V, Audigé L, et al. Internal fixation of unstable proximal humerus fractures with an anatomically preshaped interlocking plate: a clinical and radiologic evaluation. J Trauma. 2007;63(6):1314–23.PubMed

34.

Kwon BK, Goertzen DJ, O’Brien PJ, Broekhuyse HM, Oxland TR. Biomechanical evaluation of proximal humeral fracture fixation supplemented with calcium phosphate cement. J bone Joint Surg Am Volume. 2002;84(6):951–61.CrossRef

35.

Kathrein S, Kralinger F, Blauth M, Schmoelz W. Biomechanical comparison of an angular stable plate with augmented and non-augmented screws in a newly developed shoulder test bench. Clin Biomech (Bristol Avon). 2013;28(3):273–7.CrossRefPubMed

36.

Arora M, Chan EK, Gupta S, Diwan AD. Polymethylmethacrylate bone cements and additives: a review of the literature. World J Orthop. 2013;4(2):67–74.CrossRefPubMedPubMedCentral

37.

Blazejak M, Hofmann-Fliri L, Büchler L, Gueorguiev B, Windolf M. In vitro temperature evaluation during cement augmentation of proximal humerus plate screw tips. Injury. 2013;44(10):1321–6.CrossRefPubMed

38.

Windolf M. [Biomechanics of implant augmentation]. Der Unfallchirurg. 2015;118(9):765–71.CrossRefPubMed

39.

Grünewald D, Langenmair E, Hirschmüller A, Maier D, Südkamp NP, Konstantinidis L. Biomechanical in vitro evaluation of a ready-to-use calcium phosphate cement implanted to augment intramedullary nail fixation of a three-part humeral head fracture model. Proceedings of the Institution of Mechanical Engineers Part H, Journal of engineering in medicine. 2019; 233(7): 706 – 11.

Title: Cement-augmented locked plate fixation proximal humerus fractures in elderly patient: a systematic review and meta-analysis
Authors: Dong-Yang Li
Kun Zhang
Publication date: 01-12-2024
Publisher: BioMed Central
Published in: BMC Musculoskeletal Disorders / Issue 1/2024
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-024-07502-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Cement-augmented locked plate fixation proximal humerus fractures in elderly patient: a systematic review and meta-analysis

Abstract

Background

Methods

Results

Conclusion

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2024

Comparison of needle and conventional arthroscopy for visualisation of predefined anatomical structures of the knee joint: a feasibility study in human cadavers and patients

Surgical outcomes of anterior column reconstruction for spinal fractures caused by minor trauma-preoperative examination of the number of intervertebral bone bridges is key to obtaining good bone fusion-

Preoperative and follow-up variations of psoas major muscle are related to S1 screw loosening in patients with degenerative lumbar spinal stenosis

Therapeutic advantage of teriparatide in very elderly patients with proximal femoral fractures: a functional and BMD analysis

The effect of screw orientation on internal fixation of Letenneur type II Hoffa fractures: a biomechanics study

Cross-sectional study of the prevalence of hyperextension of the first metatarsophalangeal joint and its relationship to onycholysis in women with hallux valgus