Antegrade intramedullary nail versus plate fixation in the treatment of humeral shaft fractures

Abstract

Protocols of systematic reviews and meta-analyses allow for planning and documentation of review methods, act as a guard against arbitrary decision making during review conduct, enable readers to assess for the presence of selective reporting against completed reviews, and, when made publicly available, reduce duplication of efforts and potentially prompt collaboration. Evidence documenting the existence of selective reporting and excessive duplication of reviews on the same or similar topics is accumulating and many calls have been made in support of the documentation and public availability of review protocols. Several efforts have emerged in recent years to rectify these problems, including development of an international register for prospective reviews (PROSPERO) and launch of the first open access journal dedicated to the exclusive publication of systematic review products, including protocols (BioMed Central's Systematic Reviews). Furthering these efforts and building on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, an international group of experts has created a guideline to improve the transparency, accuracy, completeness, and frequency of documented systematic review and meta-analysis protocols-PRISMA-P (for protocols) 2015. The PRISMA-P checklist contains 17 items considered to be essential and minimum components of a systematic review or meta-analysis protocol. This PRISMA-P 2015 Explanation and Elaboration paper provides readers with a full understanding of and evidence about the necessity of each item as well as a model example from an existing published protocol. This paper should be read together with the PRISMA-P 2015 statement. Systematic review authors and assessors are strongly encouraged to make use of PRISMA-P when drafting and appraising review protocols. Various international organizations such as the Cochrane and Campbell Collaborations and the Agency for Healthcare Research and Quality (AHRQ) regularly require and publish protocols. However, outside of such organizations, few protocols are published in traditional journals and most reports of completed reviews (89%) do not mention working from a protocol 1 (2014 update under way). Many experts have called for improved documentation and availability of review protocols. In response, experts (some of whom are authors on this document) launched an international, prospective register for systematic review protocols (PROSPERO, www.crd.york.ac.

Outcome of humeral shaft fractures

“…Hongjie Wen et al in 2019 performed a meta-analysis to compare the efficacy and safety between antegrade IMN and plating for humeral shaft fracture, concluding that IMN may be superior to open reduction and internal fixation (ORIF) in reducing blood loss and post-operative infections, but inferior to minimally invasive plate osteosynthesis (MIPO) in nonunion rate. In the same study they found no statistically significant differences in operation time, functional results (evaluated with American Shoulder and Elbow Surgeons (ASES) score), rate of nerve injury, delayed union and need for reoperation 27 ( Figs. 5A, B; Figs.…”

“…Although several studies have compared the clinical outcomes of plating versus intramedullary nailing (IMN) in the treatment of humeral shaft fractures, the optimal surgical treatment remains controversial [26][27][28] . Hongjie Wen et al in 2019 performed a meta-analysis to compare the efficacy and safety between antegrade IMN and plating for humeral shaft fracture, concluding that IMN may be superior to open reduction and internal fixation (ORIF) in reducing blood loss and post-operative infections, but inferior to minimally invasive plate osteosynthesis (MIPO) in nonunion rate.…”

Comparison of Outcomes of Nailing Versus Plating in Humeral Diaphyseal Fractures in Adults

“…A meta-analysis was performed by Heinemann et al in 2010, where they did not find any noteworthy statistical difference between implants and in the rate of total complications,nerve-palsy non-union, ,infections or the need for reoperation. 16 For patients with humeral shaft fractures surgical treatment is usually indicated there is a neurovascular injury, open fractures, or where there is an associated elbow and forearm fractures, and polytrauma. Currently on the surgical protocol of humeral shaft fracture there is no clear agreement and guidance.…”

“…A retrospective study was done by Davies et al where it was suggested that humeral MIPO results in remarkably lower pooled major complication rate than that of IMN. 16…”

New precontoured long locking plate for proximal metadiaphyseal fractures of the humerus: a cadaveric study for its use with the minimally invasive technique

“…Meta-analysis have shown advantages of MIPO plates over endomedullary nails in nonunion rates and over open reduction and internal fixation in iatrogenic neurologic injury rates. 15 , 16 Compared with plate open reduction and internal fixation and endomedullary nails, the MIPO plate technique has also shown better clinical outcomes with a lower rate of complications. 6 Proximal metadiaphyseal fractures require long proximal humerus locking plates for stabilization making MIPO technique especially challenging in this area.…”