Complex proximal humeral fractures in adults - a systematic review of management

We performed a systematic review of the literature to compare the clinical outcomes of the management of three and four part fractures of the proximal humerus by conservative regimes, internal and external fixations and arthr oplasty. We identified 147 reports of comparative trials and case series be tween 1969 and 1999. We selected only studies dealing exclusively with thre e and four part fractures of the proximal humerus, with at least 15 patient s, treated within 48 h of injury by one of the three modalities studied, in which at least one of the outcomes of interest (pain, range of motion, inf ection and restoration of anatomy) was described. Also, to be included, stu dies had to have a follow-up period of at least 6 months, in which a minimu m of 85% of patients were followed-up. Twenty four reports met our eligibil ity criteria. Conservatively managed patients had more pain and a poorer ra nge of motion than those managed by either fixation or arthroplasty. Better restoration of anatomy was delivered in the fixation group. There was no s ignificant difference in the functional range of motion between the arthrop lasty and fixation groups, but there were very few studies available to com pare infection rates in these two management modalities. The results from t he present systematic review suggest that the data from the published liter ature are inadequate for evidence-based decision making with regards to the treatment of complex proximal humeral fractures. (C) 2001 Elsevier Science Ltd. All rights reserved.