Operative Management of Proximal Humerus Nonunions in Adults: A Systematic Review

Area of Science:

• Orthopedic surgery
• Traumatology
• Musculoskeletal research

Background:

• Proximal humerus nonunions present a significant challenge in adult orthopedic care.
• Effective management strategies are crucial for restoring shoulder function and patient quality of life.

Purpose of the Study:

• To systematically review operative interventions for adult proximal humerus nonunions.
• To identify prognostic factors influencing outcomes of locked plate open reduction and internal fixation (ORIF).

Main Methods:

• A comprehensive literature search was conducted across major databases (PubMed, EMBASE, MEDLINE, Scopus, Cochrane) from 1990 to 2020.
• Studies reporting outcomes for ORIF, hemiarthroplasty (HA), total shoulder arthroplasty (TSA), or reverse TSA (RTSA) were included.
• Data extraction and quality appraisal were performed independently by two authors.

Main Results:

• Thirty-seven articles involving 508 patients were analyzed.
• Locked plate ORIF achieved a 97.0% union rate with comparable clinical outcomes across different plate constructs.
• Arthroplasty comparison showed RTSA offered greater forward flexion but reduced external rotation compared to HA/TSA.
• Factors influencing ORIF consolidation included initial conservative management and autograft use.

Conclusions:

• Locked plate ORIF is an effective treatment for proximal humerus nonunions, yielding high union rates.
• Clinical outcomes for ORIF are generally favorable, though complication rates necessitate careful consideration.
• Reverse TSA may be preferred for improved forward flexion in arthroplasty options for nonunions, despite reduced external rotation.