Effects of fibular strut augmentation for the open reduction and internal fixation of proximal humeral fractures: a systematic review and meta-analysis

Abstract

Background: There is still a lack of remarkable consensus regarding the clinical efficacy of the application of fibular strut augmentation (FSA) combined with a locking plate for proximal humeral fractures. A systematic review and meta-analysis to assess the effect of the use of FSAs in open reduction and internal fixation of proximal humeral fractures was conducted.

Methods: A literature search was conducted in PubMed, Embase, Cochrane, Web of Science Core Collection, and ClinicalTrials.gov to identify trials that compared the clinical outcomes of proximal humeral fractures treated using a locking plate with or without FSA. The primary outcome measures were postoperative complications, radiographical findings, functional recovery scores, and postoperative range of motion (ROM). Data were pooled and analysed using a random-effects model based on the Der Simonian and Laird method.

Results: Eight studies involving 596 participants were included for further analysis. Compared with using a locking plate independently, the additional application of FSA was associated with the likelihood of lower risk of overall complications (OR 0.37; 95% CI 0.22-0.65; I² = 12.22%; 95% PI 0.14-0.98) and the rate of patients with orthopaedic complications (OR 0.48; 95% CI 0.25-0.92; I² = 7.52%; 95% PI 0.16-1.45), less changes in postoperative humeral head height (MD - 2.40; 95% CI - 2.49 to - 2.31; I² = 0.00%; 95% PI - 2.61 to - 2.20) and the neck-shaft angle (MD - 6.30; 95% CI - 7.23 to - 5.36; I² = 79.32%; 95% PI - 10.06 to - 2.53), superior functional outcomes (Constant-Murley score: MD 5.07; 95% CI 3.40 to 6.74; I² = 0.00%; 95% PI 2.361-7.78; American Shoulder and Elbow Surgeons Score: MD 5.08; 95% CI 3.67 to 6.49; I² = 0.00%; 95% PI 1.98-8.18), and better postoperative ROM in terms of forward elevation and external rotation. However, the evidence regarding postoperative abduction was insufficient.

Conclusion: Meta-analytic pooling of current evidence showed a significant association between the application of FSAs and favourable clinical outcomes in terms of postoperative complications, radiographical findings, functional recovery, and postoperative elevation and external rotation.

Keywords: Fibular strut augmentation; Locking plate; Meta-analysis; Open reduction and internal fixation; Proximal humeral fracture; Review.