Intramedullary Nails vs Open Reduction in Internal Fixation for Humeral Shaft Fractures: A Meta-Analysis of Randomized Control Trials.

Abstract

The purpose of this study was to perform a meta-analysis of randomized controlled trials (RCTs) to compare outcomes following intramedullary nailing (IMN) vs. open reduction and internal fixation (ORIF) of humeral shaft fractures. A literature search of three databases was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RCTs comparing IMN and ORIF for humeral shaft fractures were included. Clinical outcomes were compared using Revman. P value < 0.05 was considered to be statistically significant. Ten RCTs with 512 patients were included. Overall, 8.4% of patients treated with IMN and 6.4% of patients with ORIF had a non-union (p = 0.57, I2 = 0%), with a significantly faster time to union with IMN (10 weeks vs 11.9 weeks , p < 0.05). There was no significant difference in re-operations (11.6% IMN vs 7.6% ORIF, p = 0.26) or radial nerve palsies (2.8% IMN vs 4.2% ORIF, p = 0.58). A lower rate of infection was noted with IMN (1.2% vs 5.3%, p < 0.5). Additionally, there was a lower operative time with IMN (61 minutes vs 88 minutes, p < 0.05). The level I evidence in the literature does not show a significant difference in union rates, re-operations or radial nerve palsies between IMN and ORIF for humerus shaft fractures. Overall, treatment with IMN results in lower infection rates, less operative time, and modestly quicker time to union. Optimal treatment strategy for humeral shaft fractures may be best informed by fracture pattern and surgeon preference.