title: Locking plate osteosynthesis in displaced 4-part fractures of the proximal humerus.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Orthopaedic Surgery, Herlev University Hospital, Herlev, Denmark. sbrorson@hotmail.com
authors.forename: Stig
authors.initials: S
authors.lastname: Brorson
authors.forename: Lars H
authors.initials: LH
authors.lastname: Frich
authors.forename: Annika
authors.initials: A
authors.lastname: Winther
authors.forename: Asbjørn
authors.initials: A
authors.lastname: Hróbjartsson
mesh_terms: D001860:Bone Plates / Q000009:adverse effects; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D006801:Humans; D012086:Reoperation; D012784:Shoulder Fractures / Q000601:surgery*; D016896:Treatment Outcome