Antegrade vs retrograde intramedullary nailing in humerus shaft fractures: A systematic review and meta-analysis

Introduction: Plate osteosynthesis, external fixators and intramedullary nails are the commonly used devices for fixation of humerus shaft fractures. Humerus nails are gradually coming into popular use. Both antegrade and retrograde nails are used for this, however no evidence clearly states the benefits of one over the other. Thus, the purpose of this study was to evaluate the available evidence comparing the complications and outcomes of antegrade versus retrograde nails.Patients and methods: We followed the Preferred Reporting Items for Meta-analyses Statement (PRISMA) guide-lines. All studies in any language comparing the use of antegrade and retrograde nailing for humerus fractures, with a minimum follow up of 12 months were included. The primary outcome measures were complications and time to union.Results: Seven studies including 384 patients (200 antegrade, 184 retrograde) were analyzed. A significantly lower complication rate was observed with retrograde nails (OR 1.77, p = 0.04, 95% CI 1.02,3.06; p = 0.04). Antegrade nails were associated with shorter operative time (MD-13.69, p > 0.00001). There was no significant difference in time to union and intra-operative blood loss between the two techniques.Conclusion: Retrograde nails have a significantly lower complication rate. However, the surgeon's experience with these devices and the location of the fracture are the primary considerations when choosing either implant Loe: Level IV.