Meta‑analysis of the efficacy of reverse total shoulder arthroplasty and open reduction and internal fixation in the treatment of proximal humerus fractures

A proximal humerus fracture (PHF) is a common type of fracture that mostly occurs in middle‑aged and elderly individuals and is often caused by indirect trauma. Severe pain typically occurs at the fracture site, accompanied by soft tissue swelling around the injured area, a limited range of motion in the shoulder joint, and visible shoulder deformity. Surgical intervention is a common treatment approach. Reverse total shoulder arthroplasty (RTSA) and open reduction and internal fixation (ORIF) are commonly used surgical methods; however, their effects on patients vary. The present meta‑analysis compares their intraoperative and postoperative outcomes to assist surgeons in making informed decisions and improving patient treatment outcomes. The aim of the present study was to compare the intraoperative and postoperative outcomes of RTSA and ORIF in the treatment of PHFs. Literature on the treatment of PHFs by RTSA and ORIF published in databases, such as Pubmed, Embase, Cinahl, Cochrane Library, CNKI and Wanfang was retrieved. A total of 232 relevant articles were retrieved, and finally, 7 studies were included. The quality of the studies was evaluated according to the Cochrane systematic review methodology. After extracting the data, meta‑analysis was performed using Review Manager 5.4 software. In the treatment of PHF, the postoperative forward flexion and abduction angles and the operation duration of ORIF were lower than those of RTSA, and the differences were statistically significant [95% confidence interval (CI) (18.64, 36.94), P<0.00001; 95% CI (0.20, 30.15), P=0.05; [95% CI (13.44, 37.65), P<0.0001]. In addition, there were no statistically significant differences between the two groups in terms of external rotation angle, DASH score, Constant score, and other outcome measures. In conclusion, in the treatment of PHF, RTSA offers improved postoperative forward flexion and abduction angles, while ORIF has the advantage of shorter operation duration. Therefore, the choice between the two surgical approaches should be based on the individual patient's condition.