title: Treatment of complex proximal humeral fracture: plate and tension band fixation versus conservative therapy.
abstract: BACKGROUND
  There is no consensus on the optimal treatment for patients with complex proximal humeral fractures. A meta-analysis was performed to evaluate clinical effectiveness of plate and tension band fixation compared with conservative therapy.
  
  
  METHODS
  We systematically searched electronic databases (Pubmed, Medline, Embase, Cochrane library and Google Scholar) to identify comparative studies and randomized controlled trials in which plate and tension band fixation was compared with conservative treatment of the complex proximal humeral fractures from 1995 to 2013. The quality of the studies was assessed and effective data were pooled for meta-analysis.
  
  
  RESULTS
  A total of 222 patients from three RCTs and three comparative studies were included in this meta-analysis (113 fractures treated with plate and tension band and 109 with conservative treatment). The primary and secondary outcomes (Constant Score, nonunion, avascular necrosis and osteoarthritis) were compared and there was no significant difference among these different treatments of this injury.
  
  
  CONCLUSIONS
  Compared with conservative treatment, internal fixation including plate and tension band did not find better shoulder function, higher rate avascular necrosis of humeral head, lower rate nonunion, and higher rate osteoarthritis. In further, high quality and large randomized trials should be recommended to make a choice between these treatment modalities.
authors.affiliation: Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Jiaotong University Shanghai, China.
authors.forename: Yangbai
authors.initials: Y
authors.lastname: Sun
authors.affiliation: Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Jiaotong University Shanghai, China.
authors.forename: Li
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Jiaotong University Shanghai, China.
authors.forename: Jiezhi
authors.initials: J
authors.lastname: Dai
authors.affiliation: Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Jiaotong University Shanghai, China.
authors.forename: Ting
authors.initials: T
authors.lastname: Wang
keywords: Plate fixation; complex proximal humeral fracture; conservative treatment; meta-analysis; tension band fixation