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

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. © 2013 Springer-Verlag.