What’s New in Orthopaedic Trauma

Abstract

The treatment of displaced proximal humeral fractures remains controversial. An updated systematic review and meta-analysis compared conservative treatment and surgical treatment (plating, nailing, or arthroplasty) of displaced fractures in adults ‡50 years of age 1 . Twenty-two trials (1,814 patients) were included, and no meaningful differences in clinical outcome or range of motion were identified. Complications were 3.3 times higher in the surgical treatment group. However, the study did not differentiate among 2-part, 3-part, or 4-part fractures. It also included both randomized controlled trials (RCTs) and comparative observational studies, which may have been impacted by a high risk of bias.Surgical treatment may be warranted in select populations. The lack of restoration of the medial column has been suggested to contribute to fixation failure. An RCT compared clinical and radiographic outcomes following locking plate fixation with (39 patients) or without (41 patients) a fibular allograft for proximal humeral fractures with medial column comminution 2 . There was no clinically important improvement in the Disabilities of the Arm, Shoulder and Hand (DASH) score or improvement in postoperative radiographs with addition of fibular allograft augmentation at 1 year.In certain fractures in the elderly population, reverse shoulder arthroplasty is chosen for definitive treatment. However, the ideal timing for a surgical procedure is unclear. A systematic review and meta-analysis compared outcomes following acute and delayed reverse shoulder arthroplasty ( ‡4 weeks after the injury) in patients ‡65 years of age 3 . Sixteen studies were included, and the overall complication rate was higher in the delayed group (18.5%) compared with the acute group (11.7%). Patients who underwent acute reverse shoulder arthroplasty also had better range-of-motion measurements as well as better American Shoulder and Elbow Surgeons (ASES) and Constant-Murley scores. The results suggest that the surgical timing of arthroplasty for fracture treatment is important.High-grade injuries to the acromioclavicular joint may warrant fixation. Controversy remains with regard to the best type of fixation. A systematic review compared outcomes following suture button fixation (363 patients) and hook plate fixation (432 patients) for acute injuries (£21 days) 4 . Fourteen comparative studies were included, with suture Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/I34).