Proximal humerus fractures in adolescents: Experience from East of Scotland.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Declaration of competing interest The authors received no financial support for the research, authorship, and/or publication of this article. 14. Eur J Orthop Surg Traumatol. 2023 Aug;33(6):2215-2242. doi: 10.1007/s00590-022-03436-3. Epub 2022 Dec 1. Surgical treatment of proximal humerus fractures: a systematic review and meta-analysis. Hohmann E(1)(2)(3), Keough N(4)(5), Glatt V(6)(7), Tetsworth K(7)(8)(9)(10). Author information: (1)Faculty of Health Sciences, Medical School, University of Pretoria, Pretoria, South Africa. drerik@burjeelspecialty.com. (2)Department of Orthopaedic Surgery and Sports Medicine, Burjeel Hospital for Advanced Surgery, Dubai, United Arab Emirates. drerik@burjeelspecialty.com. (3)Burjeel Hospital for Advanced Surgery, Dubai, United Arab Emirates. drerik@burjeelspecialty.com. (4)Department of Anatomy and Cellular Biology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates. (5)Department of Anatomy, Faculty of Health Sciences, School of Medicine, University of Pretoria, Pretoria, South Africa. (6)Department of Orthopaedics, University of Texas Health Science Center, San Antonio, TX, USA. (7)Orthopaedic Research Centre of Australia, Brisbane, Australia. (8)Department of Orthopaedic Surgery, Royal Brisbane Hospital, Herston, Australia. (9)Department of Surgery, School of Medicine, University of Queensland, Brisbane, Australia. (10)Limb Reconstruction Center, Macquarie University Hospital, Macquarie Park, Australia. INTRODUCTION: The purpose of this study was to perform a systematic review and meta-analysis of both randomized controlled and observational studies comparing surgical interventions for proximal humerus fractures. METHODS: Systematic review of Medline, Embase, Scopus, and Google Scholar, including all level 1-3 studies from 2000 to 2022 comparing surgical treatment with ORIF, IM nailing, hemiarthroplasty, total and reverse shoulder arthroplasty (RTS) was conducted. Clinical outcome scores, range of motion (ROM), and complications were included. Risk of bias was assessed using the Cochrane Collaboration's ROB2 tool and ROBINs-I tool. The GRADE system was used to assess the overall quality of the body of evidence. Heterogeneity was assessed using χ2 and I2 statistics. RESULTS: Thirty-five studies were included in the analysis. Twenty-five studies had a high risk of bias and were of low and very low quality. Comparisons between ORIF and hemiarthroplasty favored ORIF for clinical outcomes (p = 0.0001), abduction (p = 0.002), flexion (p = 0.001), and external rotation (p = 0.007). Comparisons between ORIF and IM nailing were not significant for clinical outcomes (p = 0.0001) or ROM. Comparisons between ORIF and RTS were not significant for clinical outcomes (p = 0.0001) but favored RTS for flexion (p = 0.02) and external rotation (p = 0.02). Comparisons between hemiarthroplasty and RTS favored RTS for clinical outcomes (p = 0.0001), abduction (p = 0.0001), and flexion (p = 0.0001). Complication rates between groups were not significant for all comparisons. CONCLUSIONS: This meta-analysis for surgical treatment of proximal humerus fractures demonstrated that ORIF is superior to hemiarthroplasty, ORIF is comparable to IM nailing, reverse shoulder arthroplasty is superior to hemiarthroplasty but comparable to ORIF with similar clinical outcomes, ROM, and complication rates. However, the study validity is compromised by high risk of bias and low level of certainty. The results should therefore be interpreted with caution. Ultimately, shared decision making should reflect the fracture characteristics, bone quality, individual surgeon's experience, the patient's functional demands, and patient expectations. LEVEL OF EVIDENCE: Level III; systematic review and meta-analysis. © 2022. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature. DOI: 10.1007/s00590-022-03436-3