Comparison Of Clinical Outcome Of Intramedullary Nail Versus Locking Plate For Two-part Proximal Humerus Fractures: A Meta-analysis

Background: Proximal humeral fractures are particularly common in clinical,especially in the aged people.With the arrival of the ageing of the population,the case rate of the PHF have further enhanced.New research shows that the morbidity rate will increase 3 times in the future 30 years.Surgical management is required for the displaced and unstable two-part proximal humerus fractures.Intramedullary nail and locking plate can get the same clinical outcomes for the treatment of two-part proximal humerus fractures,but how to choose is still controversial.Objective: Taking into account the differences between different fracture types,this research define the fracture type,two-part proximal humerus fracture.To compare the clinical outcome of intramedullary nail with locking plate in the treatment of two-part proximal humerus fractures by Meta-analysis.Methods: We searched pubmed,Springer Link,EMBASE,The Cochrane Library,Medline,Science Direct,CNKI,Wan Fang Data and VIP databases for studies comparing intramedullary nail and locking plate treatment of two-part proximal humerus fractures from 1996 to 2016.The data were extracted and a Meta-analysis was made using Rev Man 5.0.Results: A total of 295 patients from seven studies were included in this meta-analysis(136 fractures treated with intramedullary nail and 159 with locking plate).There were no significant differences in the Constant Score(WMD=-2.84,95%CI(–5.90,0.22),P=0.07),postoperative complications rate(OR=0.89,95%CI(0.43,1.84),P=0.76)between the nail group and the plate group.The nail group showed superiority compared with the plate group in intraoperative blood loss(WMD=-114.18,95%CI(–169.91,-58.45),P<0.0001),surgery time(WMD=-27.71,95%CI(–36.07,-19.35),P<0.05)and bone union time(WMD=–2.91,95%CI(–5.80,-0.01),P=0.05).Conclusion: Intramedullary nail and locking plate can get the same clinical outcomes for the treatment of two-part proximal humerus fractures.Intramedullary nail is superior to locking plate in intraoperative blood loss,surgery time and bone union time,but the Constant Score,postoperative complications rate remain a topic of debate,more prospective randomized trials with large sample data are needed.