SynthesisJournal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology2025
The effects of augmentation choices for locking plate fixation in proximal humerus fracture osteosynthesis: a systematic review and meta-analysis.
Synthesis in Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Hydroxyapatite/poly-L-lactide mesh tube versus β-tricalcium phosphate granules in locking plate fixation of proximal humeral fractures: a retrospective comparative study.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026Article
- Analysis of factors associated with persistent night pain after locking plate fixation of proximal humerus fractures and development of a prediction model.BMC musculoskeletal disorders · 2026Observational
- Imaging-based assessment of fracture stability does not reliably predict outcomes in patients with two-part proximal humeral fractures and may lead to unnecessary surgeries.EFORT open reviews · 2026Review
- ORIF of three- and four-part proximal humeral fractures: a retrospective study of long-term clinical and complication outcomes of two-plate fixation methods.Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology · 2026Article
- A biomechanical comparison of fibular strut and femoral head allograft for augmented locking plate fixation in three-part proximal humerus fractures.JSES international · 2026Article
- Radiological Outcomes, Complications, and the Influence of Risk Factors in PHILOS Repair of Three- and Four-Part Proximal Humerus Fractures with and Without Femoral Head Allograft: Insights from a Cohort of 116 Patients.Journal of clinical medicine · 2026Article
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Authors and funding
7 authors.
Funding
Abstract
backgroundVarious augmentation choices have been reported to improve outcomes following locking plate fixation for proximal humerus fracture, but their effectiveness and safety are still under investigation. This study aims to investigate the effects of augmentation choices, including bone grafts, cement, and intramedullary plates, in locking plate fixation for proximal humerus fractures.
methodsPubMed, Embase, and Cochrane Library were searched for studies up to April 2024. A random-effects meta-analysis was performed within a frequentist framework.
resultsA total of 35 studies, comprising 6 randomized controlled trials and 29 nonrandomized studies of intervention with a total of 37,494 patients, were included in this review. After adjusting for small-study bias, locking plate fixation with bone grafts or cement did not affect overall complication risk (risk ratio [RR]: 1.03, 95% confidence interval [CI] 0.74-1.45), the screw protrusion risk (RR: 0.74, 95% CI 0.45-1.13), and the avascular necrosis risk (RR: 0.98, 95% CI 0.73-1.32) compared with locking plates alone. Augmentation showed small-to-moderate effects on pain reduction and functional improvement and reduced changes in humeral head height and neck-shaft angle. In subgroup analyses, cement augmentation, while possibly inferior to bone grafts in pain relief and function, showed comparable effects on radiographic outcomes. No significant difference between strut fibular and non-fibular grafts was observed.
conclusionsAugmentation with bone grafts or cement does not convincingly reduce complication risks or screw protrusion compared with locking plate fixation alone. However, it improves pain, function, and radiographic outcomes in osteosynthesis of proximal humerus fractures. LEVEL OF EVIDENCE: II. REGISTRATION: CRD42024500403.
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