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.