Outcome of shoulder hemiarthroplasty in acute proximal humeral fractures: a frustrating meta-analysis experience.

Limited evidence is available on the optimal treatment of complex fractures of the proximal humerus. No randomized prospective studies have compared hemiarthroplasty, open reduction internal fixation and/or conservative treatment. Two systematic reviews are available but they do not include angle-stable plate osteosynthesis or third-generation prosthetic designs. We conducted a systematic review of studies published in the last 10 years. The MOOSE guidelines were followed and we focused on functional outcome and its relation to age, gender and tuberosity healing after hemiarthroplasty. Sixteen studies met the inclusion criteria. We found a correlation between increasing age and decreasing Constant score (r = -0.60, p = 0.0142). Tuberosity healing has influenced functional outcome in all series mentioning this parameter. Hemiarthroplasty remains a valuable option for the treatment of proximal humerus fractures in elderly patients. However the quality of the available reports is poor. Large-scale, structured, prospective studies are needed to determine the current place of hemiarthroplasty of the shoulder in treatment of fractures of the proximal humerus.