Complications in humeral shaft fractures – non-union, iatrogenic radial nerve palsy, and postoperative infection: a systematic review and meta-analysis

Abstract

The aim of this systematic review and meta-analysis was to assess risk for iatrogenic radial nerve palsy (iRNP), non-union, and post-operative infection in humeral shaft fractures. A PubMed search including original articles comparing different treatments for humeral shaft fractures published since January 2000 was performed. Random effect models with relative risks (RR) and 95% CIs were calculated for treatment groups and outcomes. Of the 841 results, 43 studies were included in the meta-analysis (11 level II, 5 level III, 27 level IV). Twenty-seven compared intramedullary nailing (IM) with ORIF, nine conservative with operative treatment, four ORIF with minimally invasive plate osteosynthesis (MIPO), and three anterior/anterolateral with posterior approach. iRNP risk was higher for ORIF vs IM (18 studies; RR: 1.80; P = 0.047), ORIF vs MIPO (4 studies; RR: 5.60; P = 0.011), and posterior vs anterior/anterolateral approach (3 studies; RR: 2.68; P = 0.005). Non-union risk was lower for operative vs conservative therapy (six studies; RR: 0.37; P < 0.001), but not significantly different between ORIF and IM (21 studies; RR: 1.00; P = 0.997), or approaches (two studies; RR: 0.36; P = 0.369). Post-operative infection risk was higher for ORIF vs IM (14 studies; RR: 1.84; P = 0.004) but not different between approaches (2 studies; RR: 0.95; P = 0.960). Surgery appears to be the method of choice when aiming to secure bony union, albeit risk for iRNP has to be considered, particularly in case of ORIF vs IM or MIPO, and posterior approach. Due to the limited number of randomised studies, evidence on the best treatment option remains moderate, though.

Comparing the Clinical and Radiographic Outcomes of Humeral Shaft Fractures by Treatment Type

“…Nonoperative management has historically been the gold standard for treating humeral shaft fractures [ 3 ]. It is inexpensive as a treatment and avoids the risks and complications inherent to surgical management, such as postoperative infections, iatrogenic nerve palsies, and complications related to anesthesia [ 6 , 13 ]. However, in considering lost wages, productivity, and workplace absences, nonoperative treatment may actually be a higher cost to society if patients treated nonoperatively remain unable to work for a longer period of time [ 14 ].…”

Preoperative estimation of humerus intramedullary nail length using clinical landmarks

“…But still, we encounter complications, such as nerve injuries, nonunion, and long cosmetically unappealing scars. 9 , 10 , 11 , 12 …”

Therapie von Humerusschaftfrakturen

“…Insgesamt stehen nur wenige qualitativ hochwertige Studien zur Verfügung, die eine konservative mit einer operativen Therapie vergleichen. Die vorliegenden Arbeiten suggerieren jedoch einen leichten Vorteil der operativen Versorgung gegenüber dem konservativen Vorgehen [26,27,28].…”