Intramedullary Nailing Versus Plate Fixation for Humeral Shaft Fractures: A Systematic Review and Meta-Analysis

被引:13
作者
Amer, Kamil M. [1 ,2 ]
Kurland, Adam M. [1 ,2 ]
Smith, Brendan [1 ,2 ]
Abdo, Zuhdi [1 ,2 ]
Amer, Rami [1 ,2 ]
Vosbikian, Michael M. [1 ,2 ]
Ahmed, Irfan H. [1 ,2 ]
机构
[1] Rutgers New Jersey Med Sch, Newark, NJ USA
[2] Rutgers New Jersey Med Sch, Dept Orthopaed Surg, Newark, NJ 07103 USA
来源
ARCHIVES OF BONE AND JOINT SURGERY-ABJS | 2022年 / 10卷 / 08期
关键词
Humeral fractures; Intramedullary nailing; Internal fracture fixation; Malunited fractures; NERVE PALSY; MANAGEMENT;
D O I
10.22038/ABJS.2021.59413.2947
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Background: The two techniques most utilized in the surgical treatment of humeral shaft fractures are open reduction internal fixation (ORIF) and intramedullary nailing (IMN). Although there have been multiple comparative clinical studies comparing outcomes for these two treatments, studies have not suggested one approach to be superior to the other. The purpose of this study is to perform a systematic literature review and meta-analysis of studies that evaluated the treatment of humeral shaft fractures with either ORIF or intramedullary nail. Methods: We conducted this meta-analysis utilizing stricter inclusion and broader exclusion criteria to examine these two common approaches. We examined those articles which have compared first-time, closed fractures of the humeral diaphysis in adults in fracture patterns that could be treated equivalently by intramedullary nail or plate fixation. The primary outcome of interest was nonunion, and studies that did not report nonunion rates were excluded. Results: There were a total of 1,926 abstracts reviewed and a total of three articles were included in the final analysis after screening. There was no significant difference in the incidence of nonunion between plating (2/111, 1.8%) and nailing (4/104, 3.9%) (P > 0.05). The mean difference in average time to union for plated fractures and nailed fractures was 1.11 weeks (95% CI 0.82 to 1.40) which was statistically significant (P < 0.05). There was a significant difference in the incidence of radial nerve palsy (12/111, 10.8%) for plating compared to nailing (0/104, 0%) (P=0.0004). There was no difference in incidence of post-operative infection between the two groups intramedullary nailing (P > 0.05). Conclusion: The results of this analysis demonstrate an increased risk of iatrogenic radial nerve injury, and a significantly shorter time to union when treating humeral shaft fractures with plating as compared to intramedullary nailing. There was no difference in the rates of nonunion or delayed union. Based on the evidence, both plating and nailing can achieve a similar treatment effect on humeral shaft fractures.
引用
收藏
页码:661 / 667
页数:7
相关论文
共 31 条
  • [1] Management of Humeral Shaft Fractures
    Carroll, Eben A.
    Schweppe, Mark
    Langfitt, Maxwell
    Miller, Anna N.
    Halvorson, Jason J.
    [J]. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS, 2012, 20 (07) : 423 - 433
  • [2] Closed humoral shaft fractures: A prospective evaluation of surgical treatment
    Chiu, FY
    Chen, CM
    Lin, CFJ
    Lo, WH
    Huang, YL
    Chen, TH
    [J]. JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1997, 43 (06): : 947 - 951
  • [3] Dynamic compression plating versus locked intramedullary nailing for humeral shaft fractures: a meta-analysis of RCTs and nonrandomized studies
    Dai, Jiezhi
    Chai, Yimin
    Wang, Chunyang
    Wen, Gen
    [J]. JOURNAL OF ORTHOPAEDIC SCIENCE, 2014, 19 (02) : 282 - 291
  • [4] Fractures of the shaft of the humerus -: An epidemiological study of 401 fractures
    Ekholm, R.
    Adami, J.
    Tidermark, J.
    Hansson, K.
    Tornkvist, H.
    Ponzer, S.
    [J]. JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME, 2006, 88B (11): : 1469 - 1473
  • [5] He SW, 2017, BIOMED RES-INDIA, V28, P133
  • [6] Minimally invasive plating versus either open reduction and plate fixation or intramedullary nailing of humeral shaft fractures: a systematic review and meta-analysis of randomized controlled trials
    Hohmann, Erik
    Glatt, Vaida
    Tetsworth, Kevin
    [J]. JOURNAL OF SHOULDER AND ELBOW SURGERY, 2016, 25 (10) : 1634 - 1642
  • [7] Minimally invasive plate osteosynthesis vs conventional fixation techniques for surgically treated humeral shaft fractures: a meta-analysis
    Hu, Xuqi
    Xu, Siqi
    Lu, Huigen
    Chen, Bao
    Zhou, Xiao
    He, Xiaojun
    Dai, Jiaping
    Zhang, Zhongwei
    Gong, Suiliang
    [J]. JOURNAL OF ORTHOPAEDIC SURGERY AND RESEARCH, 2016, 11
  • [8] Khalafallah A, 2010, MEDITERR J HEMATOL I, V2, DOI [10.4084/MJHID.2010.005, 10.1136/bmj.l4898]
  • [9] Humeral shaft fracture: a randomized controlled trial of nonoperative versus operative management (plate fixation)
    Khameneh, Seyed Mandi Hosseini
    Abbasian, Mohammad Reza
    Abrishamkarzadeh, Hashem
    Bagheri, Shahab
    Abdollahimajd, Fahimeh
    Safdari, Farshad
    Rahimi-Dehgolan, Shahram
    [J]. ORTHOPEDIC RESEARCH AND REVIEWS, 2019, 11 : 141 - 147
  • [10] The results of functional (Sarmiento) bracing of humeral shaft fractures
    Koch, PP
    Gross, DFL
    Gerber, C
    [J]. JOURNAL OF SHOULDER AND ELBOW SURGERY, 2002, 11 (02) : 143 - 150