Fixation with Purpose: A Comprehensive Review of Locking Plate Outcomes in Displaced Proximal Humerus Fractures
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Abstract
Background: Proximal humerus fracture (PHF) is common in the geriatric and young population, and locking plate fixation is a standard surgical procedure for displaced fractures. Despite technological advances, rates of complications remain unpredictable, thus its effectiveness is questioned. Aim and Objective: This study aimed to answer the significant question: “How do surgical methods, patient variables, and fracture complexity affect the complication rates of locking plate fixation, and what are the risk factors that can be modulated?” Methods: Studies published between 2014 and 2025 were searched on PubMed, Scopus and Embase. Available complication rates of locking plate fixation of adults with displaced 2-, 3-, or 4-part PHFs were considered in the studies. Thirteen studies were considered for the systematic review of which six studies were meta-analyzed for complication proportions in a random-effects model. Results: Meta-analysis of six trials (n=818) showed a mean overall complication rate of 17.9% (95% CI: 0.068–0.374). Complications were screw cut-out (4.1%), AVN (3–23%), and failure of implant (5%). The large trials showed higher rates (24-29.5%). Conclusion: Locking plate fixation has a moderate risk of complications that is dependent on fracture and patient age. Augmentation and anatomic reduction can decrease risks. Additional research is indicated for optimal protocols.
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Copyright (c) 2025 Arun Raja C J, Sajjad Ali B, Swathi N
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