Locking plate fixation versus intramedullary nailing fixation in displaced proximal humerus fractures: A meta-analysis of randomized controlled trials.

BACKGROUND: Proximal humerus fractures (PHFs) are common injuries in older adults. However, the optimal approach to open reduction and internal fixation (ORIF) of PHFs remains a subject of debate. We conducted an updated systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the clinical outcomes between locking plate (LP) and intramedullary nailing (IMN) fixation in ORIF of PHFs with a focus on fracture type. METHODS: We searched PubMed, EMBASE, the Cochrane Library, Scopus, and the ClinicalTrials.gov registry for RCTs published before December 2022. The effects of fixation methods were estimated using odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (95% CI) and a random-effects model. Subgroup analyses were conducted by follow-up period and fracture type. RESULTS: We identified 6 RCTs involving 421 patients. The test of follow-up subgroup differences revealed that IMN fixation tended to yield faster recovery of shoulder joint function than LP fixation. The two approaches did not differ in total complications, but the IMN group had a lower OR for protrusion/cut-out than the LP group in the 2-part (OR: 0.12, 95% CI: 0.01, 0.98) and mixed result reported (OR: 0.28, 95% CI: 0.08, 0.95) subgroups. CONCLUSION: No significant differences in treatment efficacy were observed between the techniques, although IMN showed a lower risk of protrusion/cut-out than LP.