nach oben

International Orthopaedics

Erschienen in:

09.11.2017 | Review Article

Locking plates versus intramedullary nails in the management of displaced proximal humeral fractures: a systematic review and meta-analysis

verfasst von: Qi Sun, Wei Ge, Gen Li, Jiezhou Wu, Guanghua Lu, Ming Cai, Shaohua Li

Erschienen in: International Orthopaedics | Ausgabe 3/2018

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To compare the clinical outcome and complications of locking plates versus intramedullary nails in patients with displaced proximal humeral fractures. Our hypothesis was that there would be no difference between these two implants with regard to clinical outcome and complications.

Methods

We performed a systemic review of PubMed, EMBASE, Clinical Trials Registry, Cochrane Central Register of Controlled Trials and Google Scholar to identify all relevant randomized controlled trials, prospective and retrospective comparative studies on April 26, 2017. The studies of locking plates compared to intramedullary nails in patients with displaced proximal humeral fractures were included. We conducted a meta-analysis of shoulder functional scores, range of motion, pain scores, and complications.

Results

This meta-analysis included 13 comparative studies with 958 patients (529 in the locking plate group and 429 in the intramedullary nail group). A significantly greater external rotation (MD = 9.67; 95% CI, 4.22–15.12; P = 0.0005) and a significantly higher penetration rate (RR = 1.75; 95% CI, 1.11–2.77; P = 0.02) were observed in the locking plate group compared with the intramedullary nail group. Constant-Murley scores, DASH scores and total complication rate were comparable between the two groups. Moreover, there were no significant differences in forward elevation, VAS scores, and other complications.

Conclusions

Current evidence indicates that locking plates and intramedullary nails have similar performance in terms of the functional scores and total complication rate. No superior treatment was suggested between locking plates and intramedullary nails for displaced proximal humeral fractures.

Nur mit Berechtigung zugänglich

Hak DJ, Mauffrey C, Hake M, Hammerberg EM, Stahel PF (2015) Ipsilateral femoral neck and shaft fractures: current diagnostic and treatment strategies. Orthopedics 38(4):247–251. https://doi.org/10.3928/01477447-20150402-05 CrossRefPubMed

Euler SA, Hengg C, Wambacher M, Spiegl UJ, Kralinger F (2015) Allogenic bone grafting for augmentation in two-part proximal humeral fracture fixation in a high-risk patient population. Arch Orthop Trauma Surg 135(1):79–87. https://doi.org/10.1007/s00402-014-2128-z CrossRefPubMed

Court-Brown CM, Garg A, McQueen MM (2001) The epidemiology of proximal humeral fractures. Acta Orthop Scand 72(4):365–371. https://doi.org/10.1080/000164701753542023 CrossRefPubMed

Launonen AP, Lepola V, Flinkkila T, Strandberg N, Ojanpera J, Rissanen P, Malmivaara A, Mattila VM, Elo P, Viljakka T, Laitinen M (2012) Conservative treatment, plate fixation, or prosthesis for proximal humeral fracture. A prospective randomized study. BMC Musculoskelet Disord 13:167. https://doi.org/10.1186/1471-2474-13-167 CrossRefPubMedPubMedCentral

Li Y, Zhao L, Zhu L, Li J, Chen A (2013) Internal fixation versus nonoperative treatment for displaced 3-part or 4-part proximal humeral fractures in elderly patients: a meta-analysis of randomized controlled trials. PLoS One 8(9):e75464. https://doi.org/10.1371/journal.pone.0075464 CrossRefPubMedPubMedCentral

Duralde XA, Leddy LR (2010) The results of ORIF of displaced unstable proximal humeral fractures using a locking plate. J Shoulder Elbow Surg 19(4):480–488. https://doi.org/10.1016/j.jse.2009.08.008 CrossRefPubMed

Sun JC, Li YL, Ning GZ, Wu Q, Feng SQ (2013) Treatment of three- and four-part proximal humeral fractures with locking proximal humerus plate. Eur J Orthop Surg Traumatol 23(6):699–704. https://doi.org/10.1007/s00590-012-1040-x CrossRefPubMed

Sudkamp N, Bayer J, Hepp P, Voigt C, Oestern H, Kaab M, Luo C, Plecko M, Wendt K, Kostler W, Konrad G (2009) Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Results of a prospective, multicenter, observational study. J Bone Jt Surg Am 91(6):1320–1328. https://doi.org/10.2106/jbjs.h.00006 CrossRef

Brunner F, Sommer C, Bahrs C, Heuwinkel R, Hafner C, Rillmann P, Kohut G, Ekelund A, Muller M, Audige L, Babst R (2009) Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate: a prospective multicenter analysis. J Orthop Trauma 23(3):163–172. https://doi.org/10.1097/BOT.0b013e3181920e5b CrossRefPubMed

10.

Thanasas C, Kontakis G, Angoules A, Limb D, Giannoudis P (2009) Treatment of proximal humerus fractures with locking plates: a systematic review. J Shoulder Elbow Surg 18(6):837–844. https://doi.org/10.1016/j.jse.2009.06.004 CrossRefPubMed

11.

Ban I, Birkelund L, Palm H, Brix M, Troelsen A (2012) Circumferential wires as a supplement to intramedullary nailing in unstable trochanteric hip fractures: 4 reoperations in 60 patients followed for 1 year. Acta Orthop 83(3):240–243. https://doi.org/10.3109/17453674.2012.665329 CrossRefPubMedPubMedCentral

12.

Fuchtmeier B, May R, Hente R, Maghsudi M, Volk M, Hammer J, Nerlich M, Prantl L (2007) Proximal humerus fractures: a comparative biomechanical analysis of intra and extramedullary implants. Arch Orthop Trauma Surg 127(6):441–447. https://doi.org/10.1007/s00402-007-0319-6 CrossRefPubMed

13.

Maier D, Jaeger M, Izadpanah K, Strohm PC, Suedkamp NP (2014) Proximal humeral fracture treatment in adults. J Bone Joint Surg Am 96(3):251–261. https://doi.org/10.2106/jbjs.l.01293 CrossRefPubMed

14.

Wang G, Mao Z, Zhang L, Zhang L, Zhao Y, Yin P, Gao L, Tang P, Kang H (2015) Meta-analysis of locking plate versus intramedullary nail for treatment of proximal humeral fractures. J Orthop Surg Res 10:122. https://doi.org/10.1186/s13018-015-0242-4 CrossRefPubMedPubMedCentral

15.

Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 4:1. https://doi.org/10.1186/2046-4053-4-1 CrossRefPubMedPubMedCentral

16.

Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73(9):712–716CrossRefPubMed

17.

Smejkal K, Lochman P, Dedek T, Trlica J, Koci J, Zvak I (2011) Surgical treatment for proximal humerus fracture. Acta Chir Orthop Traumatol Cechoslov 78(4):321–327

18.

Zhu Y, Lu Y, Shen J, Zhang J, Jiang C (2011) Locking intramedullary nails and locking plates in the treatment of two-part proximal humeral surgical neck fractures: a prospective randomized trial with a minimum of three years of follow-up. J Bone Joint Surg Am 93(2):159–168. https://doi.org/10.2106/JBJS.J.00155 CrossRefPubMed

19.

Gracitelli ME, Malavolta EA, Assuncao JH, Kojima KE, dos Reis PR, Silva JS, Ferreira Neto AA, Hernandez AJ (2016) Locking intramedullary nails compared with locking plates for two- and three-part proximal humeral surgical neck fractures: a randomized controlled trial. J Shoulder Elbow Surg 25(5):695–703. https://doi.org/10.1016/j.jse.2016.02.003 CrossRefPubMed

20.

Gradl G, Dietze A, Kääb M, Hopfenmüller W, Mittlmeier T (2009) Is locking nailing of humeral head fractures superior to locking plate fixation? Clin Orthop Relat Res 467(11):2986–2993. https://doi.org/10.1007/s11999-009-0916-5 CrossRefPubMedPubMedCentral

21.

Konrad G, Audigé L, Lambert S, Hertel R, Südkamp NP (2012) Similar outcomes for nail versus plate fixation of three-part proximal humeral fractures. Clin Orthop Relat Res 470(2):602–609. https://doi.org/10.1007/s11999-011-2056-y CrossRefPubMed

22.

Trepat AD, Popescu D, Fernández-Valencia JA, Cuñé J, Rios M, Prat S (2012) Comparative study between locking plates versus proximal humeral nail for the treatment of 2-part proximal humeral fractures. Eur J Orthop Surg Traumatol 22(5):373–379. https://doi.org/10.1007/s00590-011-0852-4 CrossRef

23.

Matziolis D, Kaeaeb M, Zandi SS, Perka C, Greiner S (2010) Surgical treatment of two-part fractures of the proximal humerus: comparison of fixed-angle plate osteosynthesis and Zifko nails. Injury 41(10):1041–1046. https://doi.org/10.1016/j.injury.2010.04.017 CrossRefPubMed

24.

Lekic N, Montero NM, Takemoto RC, Davidovitch RI, Egol KA (2012) Treatment of two-part proximal humerus fractures: intramedullary nail compared to locked plating. HSS J 8(2):86–91. https://doi.org/10.1007/s11420-012-9274-z CrossRefPubMedPubMedCentral

25.

Urda A, Gonzalez A, Colino A, Lopiz Y, Garcia-Fernandez C, Marco F (2012) Management of displaced surgical neck fractures of the humerus: health related quality of life, functional and radiographic results. Injury 43(Suppl 2):S12–S19. https://doi.org/10.1016/s0020-1383(13)70174-8 CrossRefPubMed

26.

Boudard G, Pomares G, Milin L, Lemonnier I, Coudane H, Mainard D, Delagoutte JP (2014) Locking plate fixation versus antegrade nailing of 3- and 4-part proximal humerus fractures in patients without osteoporosis. Comparative retrospective study of 63 cases. Orthop Traumatol Surg Res 100(8):917–924. https://doi.org/10.1016/j.otsr.2014.09.021 CrossRefPubMed

27.

Tamimi I, Montesa G, Collado F, González D, Carnero P, Rojas F, Nagib M, Pérez V, Álvarez M, Tamimi F (2015) Displaced proximal humeral fractures: when is surgery necessary? Injury 46(10):1921–1929. https://doi.org/10.1016/j.injury.2015.05.049 CrossRefPubMed

28.

von Ruden C, Trapp O, Hierholzer C, Prohaska S, Wurm S, Buhren V (2015) Intramedullary nailing vs. locking plate osteosynthesis in proximal humeral fractures: long-term outcome. Unfallchirurg 118(8):686–692. https://doi.org/10.1007/s00113-013-2530-y CrossRef

29.

Gadea F, Favard L, Boileau P, Cuny C, d’Ollone T, Saragaglia D, Sirveaux F (2017) Fixation of 4-part fractures of the proximal humerus: can we identify radiological criteria that support locking plates or IM nailing? Comparative, retrospective study of 107 cases. Orthop Traumatol: Surg Res 102(8):963–970. https://doi.org/10.1016/j.otsr.2016.09.015

30.

Hauschild O, Konrad G, Audige L, de Boer P, Lambert SM, Hertel R, Sudkamp NP (2013) Operative versus non-operative treatment for two-part surgical neck fractures of the proximal humerus. Arch Orthop Trauma Surg 133(10):1385–1393. https://doi.org/10.1007/s00402-013-1798-2 CrossRefPubMed

31.

Olerud P, Ahrengart L, Ponzer S, Saving J, Tidermark J (2011) Internal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elb Surg 20(5):747–755. https://doi.org/10.1016/j.jse.2010.12.018 CrossRef

32.

Lanting B, MacDermid J, Drosdowech D, Faber KJ (2008) Proximal humeral fractures: a systematic review of treatment modalities. J Shoulder Elb Surg 17(1):42–54. https://doi.org/10.1016/j.jse.2007.03.016 CrossRef

33.

Burkhart KJ, Dietz SO, Bastian L, Thelen U, Hoffmann R, Muller LP (2013) The treatment of proximal humeral fracture in adults. Dtsch Arztebl Int 110(35–36):591–597. https://doi.org/10.3238/arztebl.2013.0591 PubMedPubMedCentral

34.

Egol KA, Ong CC, Walsh M, Jazrawi LM, Tejwani NC, Zuckerman JD (2008) Early complications in proximal humerus fractures (OTA types 11) treated with locked plates. J Orthop Trauma 22(3):159–164. https://doi.org/10.1097/BOT.0b013e318169ef2a CrossRefPubMed

35.

Owsley KC, Gorczyca JT (2008) Fracture displacement and screw cutout after open reduction and locked plate fixation of proximal humeral fractures [corrected]. J Bone Joint Surg Am 90(2):233–240. https://doi.org/10.2106/jbjs.f.01351 CrossRefPubMed

36.

Schliemann B, Wahnert D, Theisen C, Herbort M, Kosters C, Raschke MJ, Weimann A (2015) How to enhance the stability of locking plate fixation of proximal humerus fractures? An overview of current biomechanical and clinical data. Injury 46(7):1207–1214. https://doi.org/10.1016/j.injury.2015.04.020 CrossRefPubMed

Titel: Locking plates versus intramedullary nails in the management of displaced proximal humeral fractures: a systematic review and meta-analysis
verfasst von: Qi Sun
Wei Ge
Gen Li
Jiezhou Wu
Guanghua Lu
Ming Cai
Shaohua Li
Publikationsdatum: 09.11.2017
Verlag: Springer Berlin Heidelberg
Erschienen in: International Orthopaedics / Ausgabe 3/2018
Print ISSN: 0341-2695
Elektronische ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-017-3683-z

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

25.04.2024 | Hypertonie | Nachrichten

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Locking plates versus intramedullary nails in the management of displaced proximal humeral fractures: a systematic review and meta-analysis

Abstract

Purpose

Methods

Results

Conclusions

Arthropedia

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

Ärztliche Empathie hilft gegen Rückenschmerzen

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Vorsicht mit hohen NSAR-Dosen bei ankylosierender Spondylitis!

Update Orthopädie und Unfallchirurgie

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 3/2018

Clinical and magnetic resonance imaging assessment of anatomical lateral ankle ligament reconstruction: comparison of tendon allograft and autograft

Multivariate analysis of factors related to radiographic knee osteoarthritis based on the comparison between football players and matched nonsportsmen

Effect of knee flexion position and combined application of tranexamic acid on blood loss following primary total knee arthroplasty: a prospective randomized controlled trial

How to accurately determine the distal femoral valgus cut angle in the valgus knee arthroplasty

Prominent and fruitful development of orthopaedic research in China

Glenoid morphology and the safe zone for protecting the suprascapular nerve during baseplate fixation in reverse shoulder arthroplasty

Arthropedia

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

Ärztliche Empathie hilft gegen Rückenschmerzen

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Vorsicht mit hohen NSAR-Dosen bei ankylosierender Spondylitis!

Update Orthopädie und Unfallchirurgie