Arthroplasty Versus Joint Preservation For Displaced 3- And 4-part Proximal Humeral Fractures:a Meta-analysis

Objective:To evaluate and compare the clinical outcomes of joint preservation versus arthroplasty in the treatment of displaced 3-or 4-part humeral fractures in randomized controlled trials using meta-analysis.Methods:Medline (January 1966 to December 2013), PubMed (January 1980 to December 2013), Embase (January 1990 to December 2013), Science (January 1990 to December 2013), Springer (January 1990 to December 2013), China National Knowledge Infrastructure (1994 to 2013), and Wanfang database (1982 to 2013) were searched for randomized controlled trials addressing joint preservation and arthroplasty for3-or4-part proximal humeral fractures. Articles meeting the inclusion criteria were included. The related data were extracted and loaded onto Comprehensive Meta-Analysis Software for meta-analysis.Results:Seven articles with 320 patients (165 patients undergoing joint preservation and 155 patients receiving arthroplasty) were accepted in this mete-analysis and all of them were high-quality English researches by modified Jadad Scale. Meta-analysis results displayed that the random-effects mean Constant score across all types was 55.9 (95%CI: 50.7-61.1; P<0.001). Constant score was higher in the joint preservation group than in the arthroplasty group (P<0.01). The study displayed significant heterogeneity (I2=88%, Q statistic= 107.6, Q=13; P<0.001). In the meta-analysis, Constant scores were decreased with increasing rate of male to female and rate of tuberosity resorption.Conclusion:These results suggested that 3-or 4-part proximal humeral fractures demonstrate improved Constant scores when treated with joint-preserving options compared with arthroplasty. Moreover, age, fracture pattern, gender ratio and complication rate are significant predictors of the Constant score. Given the observed heterogeneity and variance in treatment techniques in the included studies, more randomized controlled trial studies are needed to definitively recommend joint-preserving techniques versus arthroplasty for treatment of 3- or 4-part proximal humeral fractures.