Conservative vs. operative treatment for humeral shaft fractures: a meta-analysis and systematic review of randomized clinical trials and observational studies

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 read the recently published systematic review and meta-analysis by van de Wall et al 5 with great interest. In this article, they compared conservative and surgical treatment of humeral shaft fractures, and 2 randomized controlled trials (RCTs) and 10 observational studies were enrolled for analysis.…”

“…First, van de Wall et al 5 told readers that this metaanalysis had 2 aims: (1) to compare surgical treatment and conservative treatment and (2) to determine whether there is a difference in effect estimates obtained from RCTs and observational studies. However, we found that the results of randomized controlled and observational studies were inconsistent for the analysis of nonunion rate and union time.…”

“…However, we found that the results of randomized controlled and observational studies were inconsistent for the analysis of nonunion rate and union time. However, van de Wall et al 5 have not explored or discussed the reason.…”

“…1 In this meta-analysis, the heterogeneity in union time was high (I 2 ¼ 84%). 5 The authors did not conduct a sensitivity analysis. To figure out the source of the high heterogeneity in this result, we performed a sensitivity analysis to evaluate the heterogeneity.…”

“…We found that conservative treatment had a shorter union time than surgical treatment, which is different from the authors' view, but our conclusion is consistent with the findings of a previous study. 2 We advise the van de Wall et al 5 to provide a sensitivity analysis and calculate new and reliable results.…”