Early post-operative outcomes of plate versus nail fixation for humeral shaft fractures

Putnam, Jill G.; Nowak, L; Sanders, David; MacNevin, Melanie; Lawendy, Abdel; Jones, Clifford B.; McKee, Michael D.; Schemitsch, Emil H.

doi:10.1016/j.injury.2019.06.014

Cited by 18 publications

(7 citation statements)

References 31 publications

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“…Altogether, the 43 studies investigated comprised 7688 patients with humeral shaft fractures. Eleven studies were randomised controlled trials (level II; 25.6%) (19, 20,21,22,23,24,25,26,27,28,29), 5 were prospective non-randomised case-control studies (III; 11.6%) (30,31,32,33,34), and 27 were retrospective cohort studies (IV; 62.8%) (6,8,9,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58). Twentyseven studies compared IM with ORIF (6,19,20,22,24,25,26,27,…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Altogether, 24 of 34 studies reporting on surgically treated patients with humeral shaft fractures provided information on post-operative infections. These included 18 studies comparing IM with ORIF (6,19,20,22,24,25,26,28,30,31,33,39,40,41,42,47,48,55), 3 comparing anterior/anterolateral with posterior approach (8, 9, 44), and 3 comparing MIPO with ORIF (21,32,46). However, the latter group was not analysed as two of the three articles reported on zero-event outcomes (21,46).…”

Section: Post-operative Infection Riskmentioning

confidence: 99%

“…However, the latter group was not analysed as two of the three articles reported on zero-event outcomes (21,46). Of the remaining 21 studies, 7 were level II (19, 20, 22, 24, 25, 26, 28), 3 level III (30,31,33), and 11 level IV (6,8,9,39,40,41,42,44,47,48,55).…”

Section: Post-operative Infection Riskmentioning

confidence: 99%

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

et al. 2022

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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.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Post-operative Infection Riskmentioning

confidence: 99%

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

et al. 2022

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“…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%).…”

Section: To the Editormentioning

confidence: 99%

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”

Yin

Xiang

2021

Journal of Shoulder and Elbow Surgery

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“…In two prospective randomized trials comparing plating and locked IM nailing 20 years ago, similar union rates were reported, although there was a higher complication rate in the IMN group 24,25 . In the last years, however, the trend has in favor of IMN [26][27][28][29] ; a good example of this orthopedic customs and traditions drift can be appreciated matching the 7 th and 9 th edition of the Rockwood and Green's Fractures in Adults 4 . New IMN designs and established surgical know-how, progressing from the first decades, could be the basis of this trend.…”

Section: Plating or Nailing?mentioning

confidence: 99%

Appropriateness of fixation methods - Trauma Meeting 2019: humeral diaphysis

Guindani

Castelli

2020

Lo Scalpello

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Humeral shaft fractures account for about 1-3% of all fractures in adults and are classified according their location, open or closed status and the pattern of fracture lines. Conservative treatment with functional bracing has been the most widely accepted treatment option in the last decades, however an increasing number of patients is treated surgically. This article overviews the indications, pros and cons of the most used fixation methods. Plates and nails are the most used devices, have widely overlapping indications, mostly depending on surgeon's preference. Plate fixation can be used for almost all humeral fractures and represent the best option for transitional fractures (proximal or distal shaft), particularly those with intra-articular involvement. MIPO techniques combines the advantages of plates with less soft tissue impairment. Fractures associated with nervous lesions deserve special considerations: the need to explore the radial nerve can drive the choice of implant more than the fracture itself. Intramedullary implants are the best option for pathological fractures of the humeral shaft, and can appropriately replace plates fixation for middle third or proximal shaft even with intra-articular simple patterns. External fixation is rarely indicated, mainly for damage control and/or extensive soft tissue damage.

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Early post-operative outcomes of plate versus nail fixation for humeral shaft fractures

Cited by 18 publications

References 31 publications

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

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

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”

Appropriateness of fixation methods - Trauma Meeting 2019: humeral diaphysis

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