Intramedullary nail versus locking plate for treatment of proximal humeral fractures: A meta-analysis based on 1384 individuals

OBJECTIVE: The optimal surgical intervention on the treatment for proximal humeral fractures (PHFs) remains uncertain. The aim of this study was to evaluate clinical outcomes following fixation of PHFs by intramedullary nails or locking plates METHODS: The Cochrane Library, PubMed, EMBASE, China Knowledge Resource Integrated (CNKI), Chongqing VIP and Wanfang databases were systematically searched for studies published between January 01, 1996 and December 31, 2016 that investigated intramedullary nail vs. locking plate in the surgical treatment of PHFs. A meta-analysis examined incision length, blood loss, operation time, fracture healing time, Constant scores and post-operative complications. The methodological and evidence quality were also assessed by MINORS and GRADE system. RESULTS: From the original 1024 references, 20 studies involving 1384 patients met the eligibility criteria. Analyses showed that intramedullary nails were superior to locking plates in incision length, peri-operative bleeding time, operation time and fracture healing time. However, there were no differences between treatments in Constant score or post-operative complications. CONCLUSION: Although the evidence quality was poor, the results suggest that compared with locking plates, intramedullary nails may be a better choice for the repair of PHFs.