Abstract
BackgroundThere are three main surgical techniques to treat humeral shaft fractures: open reduction and plate fixation (ORPF), intramedullary nail (IMN) fixation, and minimally invasive percutaneous osteosynthesis (MIPO). We performed a network meta-analysis to compare three surgical procedures, including ORPF, IMN fixation, and MIPO, to provide the optimum treatment for humerus shaft fractures.MethodsMEDLINE, EMBASE, Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, and Cochrane library were researched for reports published up to May 2016. We only included randomized controlled trials (RCTs) comparing two or more of the three surgical procedures, including the ORPF, IMN, and MIPO techniques, for humeral shaft fractures in adults. The methodological quality was evaluated based on the Cochrane risk of bias tool. We used WinBUGS1.4 to conduct this Bayesian network meta-analysis. We used the odd ratios (ORs) with 95% confidence intervals (CIs) to calculate the dichotomous outcomes and analyzed the percentages of the surface under the cumulative ranking curve.ResultsSeventeen eligible publications reporting 16 RCTs were included in this study. Eight hundred and thirty-two participants were randomized to receive one of three surgical procedures. The results showed that shoulder impingement occurred more commonly in the IMN group than with either ORPF (OR, 0.13; 95% CI, 0.03–0.37) or MIPO fixation (OR, 0.08; 95% CI, 0.00–0.69). Iatrogenic radial nerve injury occurred more commonly in the ORPF group than in the MIPO group (OR, 11.09; 95% CI, 1.80–124.20). There were no significant differences among the three procedures in nonunion, delayed union, and infection.ConclusionCompared with IMN and ORPF, MIPO technique is the preferred treatment method for humeral shaft fractures.
Highlights
Fractures of the humerus shaft are relatively common, with an annual incidence rate varying from 12.0 and 23.4 fractures per 100,000 people and an increasing incidence with age.[1]
Seventeen eligible publications reporting 16 randomized controlled trials (RCTs) were included in this study
The results showed that shoulder impingement occurred more commonly in the intramedullary nail (IMN) group than with either open reduction and plate fixation (ORPF) (OR, 0.13; 95% confidence intervals (CIs), 0.03–0.37) or minimally invasive percutaneous osteosynthesis (MIPO) fixation (OR, 0.08; 95% CI, 0.00–0.69)
Summary
Fractures of the humerus shaft are relatively common, with an annual incidence rate varying from 12.0 and 23.4 fractures per 100,000 people and an increasing incidence with age.[1]. Open reduction and plate fixation (ORPF) allows direct visualization and anatomic reduction and has potential disadvantages, such as radial nerve injury, and the risk of nonunion and deep infection resulting from extensive soft-tissue stripping.[4] Locked IMN is the commonly used method of fixation for humeral shaft fracture. Locked IMNs are load-sharing devices that have less stress shielding, minimize the disruption of fracture biology, and allow the preservation of the periosteal blood supply.[5] the shoulder complications caused by IMN, such as shoulder impingement, cannot be neglected.[6, 7] Recently, the minimally invasive percutaneous osteosynthesis (MIPO) technique has been advocated to treat humeral shaft fractures.[8, 9] This technique minimizes the disruption of the fracture site and limits soft-tissue stripping compared with conventional open reduction and internal fixation.[4, 10]. We performed a network meta-analysis to compare three surgical procedures, including ORPF, IMN fixation, and MIPO, to provide the optimum treatment for humerus shaft fractures
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