title: Surgical management of complex proximal humerus fractures-a systematic review of 92 studies including 4500 patients.
abstract: OBJECTIVE
  To compare the outcomes of open reduction and internal fixation (ORIF), closed reduction and percutaneous pinning, hemiarthroplasty (HA), and reverse shoulder arthroplasty (RSA) for proximal humerus fractures.
  
  
  METHODS
  The search was performed on September 9, 2012 using an explicit search algorithm in the following databases: Medline, SportDiscus, CINAHL, and Cochrane Central Register of Controlled Trials. Inclusion criteria were English language studies reporting clinical outcomes after surgical treatment of 3- or 4-part proximal humerus fractures with a minimum of 1-year follow-up.
  
  
  METHODS
  English language studies reporting clinical outcomes after surgical treatment of 3- or 4-part proximal humerus fractures with a minimum of 1-year follow-up. Levels 1-4 studies were eligible for inclusion.
  
  
  METHODS
  Study methodological quality and bias was evaluated using the Modified Coleman Methodology Score.
  
  
  RESULTS
  Two-proportion Z test and multivariate linear regression analyses were used for group comparisons.
  
  
  CONCLUSIONS
  Significantly better clinical outcomes were observed for ORIF over HA and RSA (American Shoulder and Elbow Score, Disabilities of Arm, Shoulder, and Hand, Constant) (P < 0.05). However, ORIF had a significantly higher reoperation rate versus HA and RSA (P < 0.001 for both). Comparing HA with RSA, there was no difference in any outcome measure. The rate of tuberosity nonunion was 15.4% in the HA group. There were more complications following closed reduction and percutaneous pinning versus ORIF, HA, and RSA (P < 0.05). ORIF for proximal humerus fractures demonstrates better clinical outcome scores but with a significantly higher reoperation rate. HA and RSA are effective as well, but tuberosity nonunion remains a concern with HA.
authors.affiliation: Division of Sports Medicine, Shoulder and Elbow Surgery, Midwest Orthopaedics at Rush, Chicago, IL.
authors.forename: Anil K
authors.initials: AK
authors.lastname: Gupta
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Harris
authors.forename: Brandon J
authors.initials: BJ
authors.lastname: Erickson
authors.forename: Geoffrey D
authors.initials: GD
authors.lastname: Abrams
authors.forename: Benjamin
authors.initials: B
authors.lastname: Bruce
authors.forename: Frank
authors.initials: F
authors.lastname: McCormick
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Nicholson
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Romeo
mesh_terms: D019643:Arthroplasty, Replacement; D005592:Fracture Fixation; D062785:Hemiarthroplasty; D006801:Humans; D012784:Shoulder Fractures / Q000601:surgery*