title: Meta-analysis of locking plate versus intramedullary nail for treatment of proximal humeral fractures.
abstract: OBJECTIVE
  This meta-analysis compared the clinical outcomes of locking plate with intramedullary nail in the treatment of displaced proximal humeral fractures.
  
  
  METHODS
  We searched PubMed, Embase, and the Cochrane databases for studies comparing locking plate and intramedullary nail treatment of displaced two-, three-, or four-part proximal humeral fractures. The quality of the studies was assessed, and meta-analysis was performed using the Cochrane Collaboration's REVMAN 5.1 software.
  
  
  RESULTS
  A total of 615 patients from eight studies were included in this meta-analysis (348 fractures treated with locking plate and 267 with intramedullary nail). Similar Constant scores were observed between the locking plate and intramedullary nail both in randomized controlled trials (RCTs) (mean difference (MD) = 2.12, 95% confidence interval (CI), -2.54 to 6.79, P = 0.37) and observational studies (MD = -1.93, 95% CI, -4.95 to 1.09, P = 0.21). Only one RCT provided American Shoulder and Elbow Surgeons Standardized scores indicating that the locking plate was better than the intramedullary nail (MD = 7.20, 95% CI, 1.29-13.11, P = 0.02). The total complication rate did not specifically favor the locking plate or intramedullary nail both in the RCTs (risk ratio (RR), 2.44; 95% CI, 0.35-16.78; P = 0.37) and observational studies (RR, 1.01; 95% CI, 0.72-1.43; P = 0.94).
  
  
  CONCLUSIONS
  In the existing literature, limited evidence suggests that the locking plate and intramedullary nail are both valuable options for the treatment of proximal humeral fractures. Because of the observed heterogeneity and variance between the subgroups, more RCT are needed to be able to definitively recommend a locking plate or intramedullary nail for specific fracture patterns.
authors.affiliation: Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China.|Department of Critical Care Medicine, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China.
authors.forename: Guoqi
authors.initials: G
authors.lastname: Wang
authors.affiliation: Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China.
authors.forename: Zhi
authors.initials: Z
authors.lastname: Mao
authors.affiliation: Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China.
authors.forename: Lihai
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China.
authors.forename: Licheng
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China.
authors.forename: Yanpeng
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China.|Medical College, Nankai University, No. 94 Weijin Road, Tianjin, 300071, People's Republic of China.
authors.forename: Peng
authors.initials: P
authors.lastname: Yin
authors.affiliation: Department of Cardiovascular Surgery, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China.
authors.forename: Ling
authors.initials: L
authors.lastname: Gao
authors.affiliation: Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China. pftang301@sina.com.
authors.forename: Peifu
authors.initials: P
authors.lastname: Tang
authors.affiliation: Department of Critical Care Medicine, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China. hjkang301@126.com.
authors.forename: Hongjun
authors.initials: H
authors.lastname: Kang
mesh_terms: D001858:Bone Nails; D001860:Bone Plates; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D006801:Humans; D006810:Humeral Fractures / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D016896:Treatment Outcome