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

Anil K. Gupta, Joshua D. Harris, Brandon J. Erickson, Geoffrey D. Abrams, Benjamin Bruce, Frank McCormick, Gregory P. Nicholson, Anthony A. Romeo

Research output: Contribution to journalReview article

68 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)54-59
Number of pages6
JournalJournal of orthopaedic trauma
Volume29
Issue number1
DOIs
StatePublished - Jan 3 2015

Keywords

  • Words: proximal humerus fracture
  • closed reduction and percutaneous pinning
  • hemiarthroplasty
  • open reduction and internal fixation
  • reverse shoulder arthroplasty
  • total shoulder arthroplasty
  • treatment

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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