Plate fixation or intramedullary fixation of humeral shaft fractures

Abstract

BackgroundThe optimal approach to operative treatment of humeral shaft fractures remains debatable. Previously published trials have been limited in size and have been inconclusive regarding important patient outcome variables following treatment with either intramedullary nails or plates. We conducted a meta-analysis of available trials comparing treatment of humeral shaft fractures.Methods We performed a literature search from 1967 to November 2007 in the main medical search engines and selected 4 randomized trials that compared nails and plates in patients with humeral shaft fractures and that reported on complications due to surgery. We statistically pooled patient data using standard meta-analytic approaches. Our primary outcome was the total complication rate, comprised of all complications listed in the articles included. Secondary outcomes included non-union, infection, nerve palsy, and reoperation rate. Methodology was assessed using the CLEAR NPT.Results When pooling the data of the 4 trials (n = 203 patients), we did not find a statistically significant difference between implants in the rate of total complications, non-union, infection, nerve-palsy, or the need for reoperation. The studies included were small and had methodological limitations.Conclusions Our meta-analysis suggests stastistically insignificant differences between plates and nails in the treatment of humeral shaft fractures. Small sample sizes, study heterogeneity, and methodological limitations argue strongly for a definitive, large trial. We recommend that this trial should be a randomized controlled trial with appropriate allocation of patients and blinding of patients and care providers and outcome assessors, and that it should include patient-important outcomes.

Intramedullary nailing of humeral shaft fractures: failure analysis of a single centre series

“…Changulani et al found that infection rates after plate osteosynthesis are four times higher than with IMN [32]. A recent meta-analysis confirmed that there is a significant correlation between plate osteosynthesis and infection, although this difference has not been reported in other publications [20,30,33,34].…”

Comparison of the Result of the Intramedullary Nail Fixation and Plate Fixation in Humeral Shaft Fracture with Butterfly Fragments

“…여러 저자들에 의해서 두 수술 술기 간 장점과 단점이 비교되었으나 [5][6][7][8][9][10][11][12] , 일반적인 상완골 간부 골절에 대한 비교에서 두 수술 술기 간에 유합률은 차이를 보이지 않는 것으로 보고되고 있다 [5][6][7][8][9][10][11][12] . 단순 상완골 간부 골절과 비교하여 골절부에 나비형 골편이 동반된 경우, 내고정 시 고정물의 생역학적 고정력에 영향을 주게 되어 13) , 나비형 골편의 전위에 따라 고정력과 유합률에 영향을 받을 수 있다 14,15) .…”

Arthroscopy-assisted versus standard intramedullary nail fixation in diaphyseal fractures of the humerus

“…1,4,11 Union rates may depend on many factors, including type of the fracture, patient-specific factors, status of smoking, age, gender, bone quality, severity of trauma, and loss of fracture hematoma secondary to open reduction. 12 In terms of length of hospital stay, while minimal length of stay (2 days) was the same in both groups, one patient in IMN group received in-hospital antibiotics of 7 days due to superficial soft tissue infection, which increased mean length of stay in the latter group. Although statistically not significant, lower length of hospital stay in AIMN group may be explained by less invasive and soft tissue-friendly nature of the performed technique.…”