LAUSR

OBJECTIVE A meta-analysis and systematic review was performed to compare outcomes of open reduction and internal fixation (ORIF), hemiarthroplasty (HA), and reverse total shoulder arthroplasty (rTSA) for complex proximal humerus fractures. DATA SOURCES MEDLINE, Embase, and Cochrane Library databases were screened. Search terms included reverse total shoulder arthroplasty, open reduction internal fixation, hemiarthroplasty, and proximal humerus fracture. STUDY SELECTION English-language studies published within the last 15 years evaluating outcomes of ORIF, rTSA, or HA for complex proximal humerus fractures with minimum of one year follow-up were included, resulting in fifty-one studies with 3,064 total patients. Review articles, basic science studies, biomechanical studies, and cadaveric studies were excluded. DATA EXTRACTION The methodological quality of evidence (MQOE) was assessed using Jadad scale and methodological index for nonrandomized studies (MINORS). DATA SYNTHESIS Demographic data were compared using chi-squared test. Mean data were weighted by study size and used to calculate composite means and confidence intervals. Continuous data were compared using the Metan module with fixed effects. Count data were compared using the Kruskal-Wallis test. Alpha was set at 0.05 for all tests. CONCLUSIONS Patients undergoing rTSA had lower risks of complication (RR 0.41) and reoperation (RR 0.28) than HA patients. rTSA resulted in higher Constant scores (SMD 0.63) and improved active forward flexion when compared to HA (SMD 0.76). Pooled mean data demonstrated better outcome scores and active forward flexion of ORIF versus HA and rTSA, though the patients were younger and had more simple fracture patterns. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.