Intramedullary Nail versus Dynamic Compression Plate Fixation in Treating Humeral Shaft Fractures: Grading the Evidence through a Meta-Analysis

Abstract

There is a debate regarding the choice of operative intervention in humeral shaft fractures that require surgical intervention. The choices for operative interventions include intramedullary nailing (IMN) and dynamic compression plate (DCP). This meta-analysis was performed to compare fracture union, functional outcomes, and complication rates in patients treated with IMN or DCP for humeral shaft fractures and to develop GRADE (Grading of Recommendations, Assessment, Development, and Evaluation)-based recommendations for using the procedures to treat humeral shaft fractures. A systematic search of all the studies published through December 2012 was conducted using the Medline, Embase, Sciencedirect, OVID and Cochrane Central databases. The randomized controlled trials (RCTs) and quasi-RCTs that compared IMN with DCP in treating adult patients with humeral shaft fractures and provided data regarding the safety and clinical effects were identified. The demographic characteristics, adverse events and clinical outcomes were manually extracted from all of the selected studies. Ten studies that included a total of 448 patients met the inclusion criteria. The results of a meta-analysis indicated that both IMN and DCP can achieve similar fracture union with a similar incidence of radial nerve injury and infection. IMN was associated with an increased risk of shoulder impingement, more restriction of shoulder movement, an increased risk of intraoperative fracture comminution, a higher incidence of implant failure, and an increased risk of re-operation. The overall GRADE system evidence quality was very low, which reduces our confidence in the recommendations of this system. DCP may be superior to IMN in the treatment of humeral shaft fractures. Because of the low quality evidence currently available, high-quality RCTs are required.

A Bayesian network meta-analysis of three different surgical procedures for the treatment of humeral shaft fractures

“…Their results showed that the effect of ORPO was similar to IMN on postoperative shoulder function. A meta-analysis of 8 RCTs and 2 quasi-RCTs by Ma et al [28] also supports this conclusion. An RCT by Benegas et al [22] evaluated the shoulder joint function after MIPO and IMN for the treatment of humeral shaft fracture, and found no significant difference between the 2 groups (P = 0.98).…”

What Factors are Associated With a Surgical Site Infection After Operative Treatment of an Elbow Fracture?

“…In prior research, olecranon osteotomy stabilized with a plate and screws was a risk factor for SSI [14], and plate and screw fixation also was found to be a risk factor for SSI in long bone fractures [29]. The data regarding SSI after plate and screw fixation of tibial plateau fractures, distal tibia fractures, proximal humerus fractures, and humeral shaft fractures are less consistent [5,8,12,15,16,23,26,30,33]. In the elbow, a higher rate of SSI in patients treated with plate and screw fixation might occur owing to the presence of implants directly underneath the wound, particularly if there is a suture abscess, wound separation, or wound edge necrosis.…”

Retrospective case series with one year follow-up after radial nerve palsy associated with humeral fractures

“…Both, ORIF and IN are well-established procedures with high rates of 85-93 % of recovery following primary radial nerve palsy [12,[17][18][19][20][21]. In the case of acute primary radial nerve palsy open reduction facilitates fracture treatment and enables simultaneous exploration of the radial nerve to determine the extent and the type of lesion [1,7,18].…”