Effect of anatomic locking plate combined with allograft fibula on proximal humerus fracture: a meta-analysis

doi:10.3969/j.issn.2095-4344.2913

Abstract

Abstract:

BACKGROUND: Proximal humeral fractures are common clinical fractures, but it is still difficult to treat the fracture without support of proximal medial column of humerus. Complications are common and the failure rate is high.

OBJECTIVE: To compare the efficacy of anatomical locking plate combined with allograft fibula and only anatomical locking plate for treating proximal humerus fracture.

METHODS: A computer was used to retrieve the PubMed, Embase, Cochrane Library, Google Scholar, CNKI, Wanfang, and VIP databases. The retrieval time was from the inception of the database to February 2020. A literature search was conducted at home and abroad on the comparative study of the effect of anatomical locking plate combined with allograft fibula versus anatomical locking plate for the treatment of proximal humerus fractures. Two researchers independently screened literature based on inclusion and exclusion criteria, extracted data, and assessed the risk of bias in the literature. Meta-analysis was performed on indicators of 12 included articles, using RevMan 5.2 software, including imaging, functional scores, and complication.

RESULTS AND CONCLUSION: (1) Twelve articles were included in the study, of which eleven were retrospectives and one was randomized controlled trials, according to the inclusion and exclusion criteria. The quality of the included research literature was high, but the grade of GRADE evidence was low. (2) There were a total of 958 patients, of which 411 cases were in the anatomical locking plate combined with the allograft fibula group, and 547 cases were in the only anatomical locking plate group. (3) Meta-analysis results demonstrated that height humeral head difference (MD=-2.40, 95%CI:-2.49 to -2.31), neck-shaft angle difference (MD=-6.14, 95%CI:-6.62 to -5.67), visual analogue scale score (MD=-0.22, 95%CI: -0.35 to -0.08), Constant-Murley score (MD=4.12, 95%CI:2.18-6.06), disabilities of the arm (MD=-10.32, 95%CI: -13.44 to -7.19), visual analogue scale score 2 years postoperatively (MD=-0.37, 95%CI: -0.55 to -0.19), Constant-Murley score 2 years postoperatively (MD=5.07, 95%CI:2.86-7.27), total complications (OR=0.31, 95%CI:0.20-0.48), and humeral head screw cut out (OR=0.25, 95%CI:0.11-0.55) were significantly superior in the anatomical locking plate combined with the allograft fibula group than in the only anatomical locking plate group (P < 0.05). There was no significant difference between the two groups in the result of humeral head necrosis (OR=0.94, 95%CI:0.47-1.88; P > 0.05). (4) Therefore, weak evidence indicated that the short-term effect of the anatomical locking plate combined with allograft fibula is better than the anatomical locking plate in the treatment of proximal humeral fractures. It can reduce complications and promote functional recovery.

Key words: bone, fracture, humerus, plate, fixation, allograft, fibula, meta-analysis

CLC Number:

Xiang Feifan, Tan Xiaoqi, Xiang Yong, Liang Jie, Zhou Wei, Luo Liang, Gu Hao, Yang Yunkang. Effect of anatomic locking plate combined with allograft fibula on proximal humerus fracture: a meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(36): 5897-5904.

Figures/Tables 14

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