BACKGROUND: The best treatment of proximal humeral fracture has always been controversial. Open reduction and internal fixation with locking plate is a common method for the treatment of proximal humeral fractures. In recent years, many studies have pointed out that locking plate combined with fibular allograft can obtain better rigid structure. OBJECTIVE: To evaluate the clinical efficacy of locking plate and locking plate combined with fibular allograft in the treatment of proximal humeral fractures. METHODS: CNKI, Wanfang database, VIP, PubMed, EMBASE, and Cochrane Library were searched for articles concerning locking plate and locking plate combined with fibular allograft for proximal humeral fractures published from inception to January 2020 for quality evaluation. International Cochrane collaboration RevMan 5.0 software was used for meta-analysis. The difference in American shoulder and elbow surgeons score, Constant score, humeral head height loss value, the change of humeral neck angle, incidence of postoperative complications, secondary surgery rate, screw cutout rate, and humeral head necrosis rate were compared between the locking plate group and locking plate combined with fibula group. RESULTS AND CONCLUSION: (1) Eight studies were included with a total of 623 patients. (2) Results analysis showed that there were significant differences between the locking plate group and locking plate combined with fibula group in American shoulder and elbow surgeons score (95%CI:4.29-6.84, P < 0.05), Constant score (95%CI:6.46-15.10, P < 0.05), humeral head height loss value (95%CI: -3.24--2.07, P < 0.05), the change of humeral neck angle (95%CI:-7.20--5.95, P < 0.05), incidence of postoperative complications (95%CI:0.18-0.51, P < 0.05), and screw cutout rate (95%CI:0.13-0.65, P < 0.05). (3) However, there was no significant difference between the two groups in secondary surgery rate (95%CI:0.13-1.14, P > 0.05) and humeral head necrosis rate(95%CI:0.41-2.11, P > 0.05). (4) Locking plate combined with fibula with simple locking plate in American shoulder and elbow surgeons score, Constant score, humeral head height loss value, neck stem Angle values, the incidence of postoperative complications, and screw cutout rate has a better clinical effect, but does not have significant difference in the second operation rate or humeral head avascular necrosis..

Osteoporosis and chronic psychological stress are two serious chronic degenerative diseases that cause disability and impact population health. Patients with osteoporosis often present with heavier psychological burden, lower quality of life, and frequent symptoms of depression and anxiety. There are potential common pathogenic factors, cellular mechanisms and signaling pathways between them. Considering that the number of patient with these diseases is huge and growing rapidly, it is particularly important to explore the pathogenic link between these two diseases as well as cross-effect therapeutics for osteoporosis and mental health disorders.

The Mediterranean diet refers to the dietary pattern derived from eating habits of the southern European countries along the Mediterranean coast. It is a healthy diet pattern with essential nutrients. It was reported that the incidence of osteoporosis in the Mediterranean countries is lower, so it is of particular interest to explore the effect and potential mechanism of the diet on bone health. Applying research results of the Mediterranean diet to the prevention of osteoporosis in other countries is a feasible way to reduce the incidence of osteoporosis in the future.