A Bayesian network meta-analysis of three different surgical procedures for the treatment of humeral shaft fractures

Abstract

Background:The optimal surgical procedure for humeral shaft fractures remains a matter of debate. We aimed to establish the optimum procedure by performing a Bayesian network meta-analysis.Methods:PubMed, EMBASE, the Cochrane Library, and Medline were searched for both randomized controlled trials and prospective studies of surgical treatment for humeral shaft fractures. The quality of the included studies was assessed according to the Cochrane Collaboration's “Risk of bias”.Results:Seventeen RCTs or prospective studies were included in the meta-analysis. The pooled results showed that the occurrence rate of radial nerve injury was lowest for minimally invasive plate osteosynthesis (MIPO; SUCRA probability, 95.1%), followed by open reduction and plate osteosynthesis (ORPO; SUCRA probability, 29.5%), and was highest for intramedullary nailing (IMN; SUCRA probability, 25.4%). The aggregated results of pairwise meta-analysis showed no significant difference in radial nerve injury rate when comparing ORPO versus IMN (OR, 1.92; 95% CI, 0.96 to 3.86), ORPO versus MIPO (OR, 3.38; 95% CI, 0.80 to 14.31), or IMN versus MIPO (OR, 3.19; 95% CI, 0.48 to 21.28). Regarding the nonunion, SUCRA probabilities were 90.5%, 40.2%, and 19.3% for MIPO, ORPO, and IMN, respectively. The aggregated results of a pairwise meta-analysis also showed no significant difference for ORPO versus IMN (OR, 0.83; 95% CI, 0.41 to 1.69), ORPO versus MIPO (OR, 2.42; 95% CI, 0.45 to 12.95), or IMN versus MIPO (OR, 2.49; 95% CI, 0.35 to 17.64).Conclusion:The current evidence indicates that MIPO is the optimum choice in the treatment of humeral shaft fractures and that ORPO is superior to IMN.

A Mobile Bayesian Network Structure Learning Method Using Genetic Incremental K2 Algorithm and Random Attribute Order Technology

“…(1) Procedure GCDK2{ (2) {Input: K2 algorithm need parameter initialisation, mutation rate pm � 0.5} (3) {Output: a bayesian network and a matrix contain optimal value and location } (4) For i � 1-n{ (5) P old � g(i, π i ) (6) While OK To Proceed and Length is OK (7) pps � mysetdiff(order(1: i − 1), ps){Potential parents} (8) nps � length(pps) (9) For pi � 1-nps{ (10) pscore(pi) � g(i, π i ∪ z { }) (11) End for} (12) [P first , best p first ] � max(pscore);{best p first is a location, P first is the max first score} (13) Get second pscore and second p (14) Get third pscore and third p (15) Get fourth pscore and fourth p (16) Mutate optimal values get a new genetic value GA pscore (17) If (P first > P old ) {P old � P first ;ps � ps best p first 􏼂 􏼃 (18) Input P first best p first second pscoresecond p,third pscore , (19) third_pfourth pscore,fourth p and GA pscoreinto candidate matrix (20) End if} (21) End while} (22) End for} (23) End GCDK2} ALGORITHM 2: GCDK2 algorithm. 4 Scientific Programming…”

“…Machine learning technologies have become more and more important in many applications, such as medicine [3], e-commerce [4,5], transportation [6], and image denoising [7]. As one of the machine learning technologies, Bayesian network is widely used in many fields, such as machine vision, biomedicine, classification, fault diagnosis, prediction, natural language processing, and data mining [8].…”

Letter to the Editor regarding van de Wall et al: “Conservative vs. operative treatment for humeral shaft fractures: a meta-analysis and systematic review of randomized clinical trials and observational studies”

“…We recommend subgroup analysis according to whether plates were used because the complications of various operations differ and show statistical differences. 3,4 Third, a high level of heterogeneity when analyzed studies could not lead to a firm conclusion according to the Cochrane Handbook for Systematic Reviews of Interventions. 1 In this meta-analysis, the heterogeneity in union time was high (I 2 ¼ 84%).…”

Fragility of statistically significant findings from randomized clinical trials of surgical treatment of humeral shaft fractures: A systematic review

“…Implant options for both ORPO and MIPO include dynamic compression plate (DCP) and locking compression plate (LCP). Numerous recent systematic reviews, meta-analysis, and network meta-analysis (NMA) review papers have been published aiming to determine the efficacy of these treatment options in order to provide reliable evidence to guide clinical decision making[ 6 , 8 - 13 ]. Based on the lack of consensus from the existing literature regarding surgical treatment of humeral shaft fractures, this manuscript aims to further assess the quality of the literature that guides treatment decisions by employing a new metric, the fragility index (FI).…”