Top

European Journal of Orthopaedic Surgery & Traumatology

Published in:

01-04-2014 | Original Article

Meta-analysis comparing locking plate fixation with hemiarthroplasty for complex proximal humeral fractures

Authors: Jiezhi Dai, Yimin Chai, Chunyang Wang, Gen Wen

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 3/2014

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.

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 PubMedCrossRef

Lind T, Kroner K, Jensen J (1989) The epidemiology of fractures of the proximal humerus. Arch Orthop Trauma Surg 108(5):285–287PubMedCrossRef

Neer CS 2nd (1970) Displaced proximal humeral fractures. II. Treatment of three-part and four-part displacement. J Bone Joint Surg Am 52(6):1090–1103PubMed

Neer CS 2nd (1970) Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am 52(6):1077–1089PubMed

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 PubMedCrossRef

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 PubMedCrossRef

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 PubMedCrossRef

Jobin CM, Galatz LM (2012) Proximal humerus fractures: pin, plate, or replace? Semin Arthroplasty 23(2):74–82CrossRef

10.

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 PubMedCentralPubMedCrossRef

11.

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):712–716PubMedCrossRef

12.

Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634PubMedCentralPubMedCrossRef

13.

Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50(4):1088–1101PubMedCrossRef

14.

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 PubMedCrossRef

15.

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 CrossRef

16.

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 PubMedCrossRef

17.

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

18.

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

19.

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):144–150CrossRef

20.

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 PubMed

21.

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

22.

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 PubMedCentralPubMedCrossRef

23.

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):85–89CrossRef

24.

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 CrossRef

25.

Nijs S, Broos P (2009) Outcome of shoulder hemiarthroplasty in acute proximal humeral fractures: a frustrating meta-analysis experience. Acta Orthop Belg 75(4):445–451PubMed

26.

Misra A, Kapur R, Maffulli N (2001) Complex proximal humeral fractures in adults—a systematic review of management. Injury 32(5):363–372PubMedCrossRef

27.

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 CrossRef

28.

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 PubMedCrossRef

29.

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 PubMedCentralPubMedCrossRef

30.

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 PubMedCrossRef

31.

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 PubMedCrossRef

32.

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 PubMedCrossRef

33.

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):92–96PubMedCentralPubMedCrossRef

34.

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 CrossRef

35.

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 CrossRef

36.

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 CrossRef

37.

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):217–219PubMedCrossRef

38.

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 CrossRef

39.

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):401–412CrossRef

40.

Mighell MA, Kolm GP, Collinge CA, Frankle MA (2003) Outcomes of hemiarthroplasty for fractures of the proximal humerus. J Should Elbow Surg 12(6):569–577CrossRef

41.

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 PubMedCrossRef

42.

DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7(3):177–188PubMedCrossRef

43.

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

44.

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 PubMedCrossRef

Title: Meta-analysis comparing locking plate fixation with hemiarthroplasty for complex proximal humeral fractures
Authors: Jiezhi Dai
Yimin Chai
Chunyang Wang
Gen Wen
Publication date: 01-04-2014
Publisher: Springer Paris
Published in: European Journal of Orthopaedic Surgery & Traumatology / Issue 3/2014
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-013-1179-0

At a glance: The STEP trials

Springer Medicine

Meta-analysis comparing locking plate fixation with hemiarthroplasty for complex proximal humeral fractures

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2014

Usefulness of cross-table lateral view radiograph for the diagnosis of cam-type femoroacetabular impingement

Secondary radial nerve palsy after internal fixation of humeral shaft fractures

The role of mesenchymal stem cells in bone repair and regeneration

Management of open infected comminuted tibial fractures using Ilizarov concept

Results of treatment of chronic osteomyelitis by “gutter procedure and muscle flap transposition operation”

Less invasive reduction and fusion of fresh A2 and A3 traumatic L1–L4 fractures with a novel vertebral body augmentation implant and short pedicle screw fixation and fusion