Locking plate osteosynthesis in displaced 4-part fractures of the proximal humerus

TY - JOUR

T1 - Locking plate osteosynthesis in displaced 4-part fractures of the proximal humerus

AU - Brorson, Stig

AU - Frich, Lars H

AU - Winther, Annika

AU - Hróbjartsson, Asbjørn

PY - 2011/8

Y1 - 2011/8

N2 - Background and purpose There is considerable uncertainty about the optimal treatment of displaced 4-part fractures of the proximal humerus. Within the last decade, locking plate technology has been considered a breakthrough in the treatment of these complex injuries. Methods We systematically identified and reviewed clinical studies on the benefits and harms after osteosynthesis with locking plates in displaced 4-part fractures. Results We included 14 studies with 374 four-part fractures. There were 10 case series, 3 retrospective observational comparative studies, 1 prospective observational comparative study, and no randomized trials. Small studies with a high risk of bias precluded reliable estimates of functional outcome. High rates of complications (1664%) and reoperations (1127%) were reported. Interpretation The empirical foundation for the value of locking plates in displaced 4-part fractures of the proximal humerus is weak. We emphasize the need for well-conducted randomized trials and observational studies.

AB - Background and purpose There is considerable uncertainty about the optimal treatment of displaced 4-part fractures of the proximal humerus. Within the last decade, locking plate technology has been considered a breakthrough in the treatment of these complex injuries. Methods We systematically identified and reviewed clinical studies on the benefits and harms after osteosynthesis with locking plates in displaced 4-part fractures. Results We included 14 studies with 374 four-part fractures. There were 10 case series, 3 retrospective observational comparative studies, 1 prospective observational comparative study, and no randomized trials. Small studies with a high risk of bias precluded reliable estimates of functional outcome. High rates of complications (1664%) and reoperations (1127%) were reported. Interpretation The empirical foundation for the value of locking plates in displaced 4-part fractures of the proximal humerus is weak. We emphasize the need for well-conducted randomized trials and observational studies.

KW - Bone Plates, Fracture Fixation, Internal, Humans, Reoperation, Shoulder Fractures, Treatment Outcome

U2 - 10.3109/17453674.2011.588856

DO - 10.3109/17453674.2011.588856

M3 - Journal article

SN - 1745-3674

VL - 82

SP - 475

EP - 481

JO - Acta Orthopaedica

JF - Acta Orthopaedica

IS - 4

ER -