Humeral shaft fractures: results of operative and non-operative treatment.

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Abstract

[Indexed for MEDLINE] 17. Eur J Trauma Emerg Surg. 2022 Aug;48(4):2667-2682. doi: 10.1007/s00068-021-01728-7. Epub 2021 Jul 5. Open plate fixation versus nailing for humeral shaft fractures: a meta-analysis and systematic review of randomised clinical trials and observational studies. Beeres FJP(1), van Veelen N(1), Houwert RM(2), Link BC(1), Heng M(3), Knobe M(1), Groenwold RHH(4), Babst R(1)(5), van de Wall BJM(6)(7). Author information: (1)Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse 16, 6000, Luzern, Switzerland. (2)Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. (3)Department of Orthopedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital Boston, Boston, USA. (4)Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands. (5)Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland. (6)Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse 16, 6000, Luzern, Switzerland. bryan_vdwall@hotmail.com. (7)Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland. bryan_vdwall@hotmail.com. Comment in Eur J Trauma Emerg Surg. 2022 Aug;48(4):2683-2684. doi: 10.1007/s00068-021-01874-y. Eur J Trauma Emerg Surg. 2022 Aug;48(4):2685-2686. doi: 10.1007/s00068-022-01943-w. PURPOSE: This meta-analysis compares open reduction and internal fixation with a plate (ORIF) versus nailing for humeral shaft fractures with regard to union, complications, general quality of life and shoulder/elbow function. METHODS: PubMed/Medline/Embase/CENTRAL/CINAHL was searched for observational studies and randomised clinical trials (RCT). Effect estimates were pooled across studies using random effects models. Results were presented as weighted odds ratio (OR) or risk difference (RD) with corresponding 95% confidence interval (95% CI). Subgroup analysis was performed stratified for study design (RCTs and observational studies). RESULTS: Eighteen observational studies (4906 patients) and ten RCT's (525 patients) were included. The pooled effect estimates of observational studies were similar to those obtained from RCT's. More patients treated with nailing required re-intervention (RD 2%; OR 2.0, 95% CI 1.0-3.8) with shoulder impingement being the most predominant indication (17%). Temporary radial nerve palsy secondary to operation occurred less frequently in the nailing group (RD 2%; OR 0.4, 95% CI 0.3-0.6). Notably, all but one of the radial nerve palsies resolved spontaneously in each groups. Nailing leads to a faster time to union (mean difference - 1.9 weeks, 95% CI - 2.9 to - 0.9), lower infection rate (RD 2%; OR 0.5, 95% CI 0.3-0.7) and shorter operation duration (mean difference - 26 min, 95% CI - 37 to - 14). No differences were found regarding non-union, general quality of life, functional shoulder scores, and total upper extremity scores. CONCLUSION: Nailing carries a lower risk of infection, postoperative radial nerve palsy, has a shorter operation duration and possibly a shorter time to union. Shoulder impingement requiring re-intervention, however, is an inherent disadvantage of nail fixation. Notably, absolute differences are small and almost all patients with radial nerve palsy recovered spontaneously. Satisfactory results can be achieved with both treatment modalities. © 2021. Springer-Verlag GmbH Germany, part of Springer Nature. DOI: 10.1007/s00068-021-01728-7