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

Abstract

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 (16–64%) and reoperations (11–27%) 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.

SB had the idea for the study and performed the literature search. LH and SB assessed the articles for eligibility. Data extraction was performed by SB and AW. Quality assessment of studies was performed by SB and AH. SB drafted the manuscript. All authors were involved in critical revision of the paper.

SB was supported financially by Göran Bauer's Grant and by the Danish Agency for Science, Technology, and Innovation.

No competing interests declared.