Abstract
BackgroundProximal humeral fractures are common lesions of the elderly, but there are no established treatment guidelines. A surgical treatment for comminuted and displaced fractures of the proximal humerus was developed and is still evolving. The aim of this study was to perform a quantitative review to evaluate the risk of avascular necrosis (AVN) in patients with proximal humeral fractures who were treated by operative fixation compared with conservative treatment.MethodsWe searched the PubMed, MEDLINE, Springer, Elsevier Science Direct, Cochrane Library, Google Scholar, China National Knowledge Infrastructure (in Chinese), and Wanfang database (in Chinese) up to December 2013 to identify studies related to operative fixation and AVN in patients with proximal humeral fractures.ResultsSeven studies with a total of 291 patients (142 operative fixation cases and 149 conservative treatment cases) with proximal humeral fractures were considered in the meta-analysis. The overall meta-analysis showed no significant difference in the incidence of AVN between the two groups [odds ratio (OR) 1.42, 95% confidence interval (CI) 0.33–6.11, p = 0.64]. The subgroup meta-analysis by study design (retrospective/prospective), sample size (≤40/>40), and ethnicity (European/Asian) demonstrated similar results. However, the subgroup analysis by specific operative approach (plate fixation/tension band wiring fixation/others) indicated that plate fixation was associated with a higher rate of AVN than conservative treatment (OR 0.20, 95% CI 0.05–0.76, p = 0.019).ConclusionsPlate fixation was associated with a higher risk of AVN development than conservative treatment in patients with proximal humeral fractures.
Highlights
Proximal humeral fractures are common lesions of the elderly, but there are no established treatment guidelines
The study had to contain (1) the occurrence rates of avascular necrosis (AVN) in patients with proximal humeral fractures, (2) operative fixation versus conservative treatment data, and (3) the effect size reported as odds ratios (ORs) and 95% confidence intervals (CIs) or it could be calculated
The results showed that there was a relatively higher risk of AVN in patients with proximal humeral fractures who underwent operative fixation than in those treated conservatively (Figure 2), but the difference was not statistically significant
Summary
Proximal humeral fractures are common lesions of the elderly, but there are no established treatment guidelines. The majority of patients suffering this injury have nondisplaced or minimally displaced twoor three-part fractures They are treated conservatively with a modified Velpeau bandage or in a sling, both of which require immobilization for more than 2 weeks [4,5]. Many surgical solutions such as operative fixations (retrograde percutaneous pin fixation [5], transcutaneous fixation with Kirschner wires [8], and tension band osteosynthesis [9]) and hemiarthroplasty [10] are applied to treat these lesions, ranging from percutaneous pinning to shoulder arthroplasty [1] These surgical solutions have added to the surgeon's armamentarium of methods to treat proximal humeral fractures and have been suitable for patients with various conditions. Open operative techniques pose a higher risk of the patient developing avascular necrosis (AVN) of the humeral head [6]
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