Minimally invasive plate osteosynthesis versus open reduction and internal fixation for humeral shaft fractures: a Meta-analysis

Abstract

Objective To compare the efficacy and safety between minimally invasive plate osteosynthesis (MIPO) and open reduction and internal fixation (ORIF) in the treatment of humeral shaft fracture. Methods Case-control studies and randomized clinical trials comparing MIPO with ORIF in the treatment of humeral shaft fracture from January 2010 to June 2018 were retrieved from PubMed Library, Cochrane Library, Embase Library, China National Knowledge Internet and Wanfang Data. Methodological quality of the studies and trials was critically assessed. REVMAN5.3 was used for data analysis. The 2 groups of patients were compared in terms of University of California, Los Angeles shoulder rating scale (UCLA), Mayo Elbow Performance Score (MEPS), union time, nonunion rate and complications. Results A total of 452 patients from 9 articles were included. There were 216 cases in the MIPO group and 236 ones in the ORIF group. The Meta analyses showed that the MIPO group had a significantly higher UCLA score (WMD=0.36, P=0.03), significantly lower incidences of complications (OR=-0.15, P<0.05) and iatrogenic radial nerve palsy (OR=0.24, P<0.05), and significantly shorter union time (SMD=-0.36, P=0.02) than the ORIF group. There were no significant differences between the 2 groups in MEPS (WMD=-0.48, P=0.43) or nonunion rate (OR=0.45, P=0.11). Conclusion MIPO may be a better choice for humeral shaft fracture than ORIF in regards to postoperative shoulder functions, union time, and incidences of complications and iatrogenic radial nerve palsy. Key words: Surgery, minimally invasive; Fracture fixation, internal; Bone plates; Meta-analysis; Humeral shaft fracture