Abstract
Introduction
There is considerable uncertainty about the optimal treatment of displaced four-part fractures of the proximal humerus. Within the last decade locking plate technology has been considered a breakthrough in the treatment of these complex injuries.
Methods
We systematically identified and reviewed clinical studies of the benefits and harms after osteosynthesis with locking plates in displaced four-part fractures.
Results
We included fourteen studies with 374 four-part fractures. There were no randomised trials, one prospective observational comparative study, three retrospective observational comparative studies, and ten case series. Small studies with a high risk of bias precluded reliable estimates of functional outcome. Unexpected high rates of complications (range 16% to 64%) and re-operations (range 11% to 27%) were reported.
Conclusion
The empirical foundation for the clinical value of locking plates in displaced four-part fractures of the proximal humerus is very sketchy. We emphasise the need for well conducted randomised trials and observational studies.
