Humeral shaft fracture: systematic review of non-operative and operative treatment

Abstract

Introduction Humeral shaft fractures can be treated non-operatively or operatively. The optimal management is subject to debate. The aim was to compare non-operative and operative treatment of a humeral shaft fracture in terms of fracture healing, complications, and functional outcome. Methods Databases of Embase, Medline ALL, Web-of-Science Core Collection, and the Cochrane Central Register of Controlled Trials (CENTRAL) were systematically searched for publications reporting clinical and functional outcomes of humeral shaft fractures after non-operative treatment with a functional brace or operative treatment by intramedullary nailing (IMN; antegrade or retrograde) or plate osteosynthesis (open plating or minimally invasive). A pooled analysis of the results was performed using MedCalc. Results A total of 173 studies, describing 11,868 patients, were included. The fracture healing rate for the non-operative group was 89% (95% confidence interval (CI) 84–92%), 94% (95% CI 92–95%) for the IMN group and 96% (95% CI 95–97%) for the plating group. The rate of secondary radial nerve palsies was 1% in patients treated non-operatively, 3% in the IMN, and 6% in the plating group. Intraoperative complications and implant failures occurred more frequently in the IMN group than in the plating group. The DASH score was the lowest (7/100; 95% CI 1–13) in the minimally invasive plate osteosynthesis group. The Constant–Murley and UCLA shoulder score were the highest [93/100 (95% CI 92–95) and 33/35 (95% CI 32–33), respectively] in the plating group. Conclusion This study suggests that even though all treatment modalities result in satisfactory outcomes, operative treatment is associated with the most favorable results. Disregarding secondary radial nerve palsy, specifically plate osteosynthesis seems to result in the highest fracture healing rates, least complications, and best functional outcomes compared with the other treatment modalities.

Correlation between Peripheric Blood Markers and Surgical Invasiveness during Humeral Shaft Fracture Osteosynthesis in Young and Middle-Aged Patients

“…Both DCPs and IMNs have their own sets of advantages and disadvantages. A recent systematic review conducted by Bergen et al [ 21 ] that included 173 studies on the subject concluded that plates have higher fracture healing rates and the least complications if radial nerve palsies are excluded. On the contrary, a study that also took into consideration operative measurements such as surgical time and intraoperative blood loss concluded that both techniques can produce similar results, although IMN was a less invasive procedure [ 22 ].…”

Assessment of therapeutic clinical trials for proximal humeral fractures

“…Moreover, the majority of the trials was started after 2010, indicating the novelty of this topic. Management of PHF was originally mostly conservative [ 38 ]. However, as years passed, integrating operative management for patients with displaced fractures showed good clinical and functional outcomes [ 39 ].…”

Enhanced nerve function recovery in radial nerve palsy patients with humerus shaft fracture: a randomized study of low-frequency pulse electrical stimulation combined with exercise therapy

“…Humeral shaft fractures account for about 3% of all orthopedic injuries ( 2 ). Radial nerve palsy (RNP) is a common complication of humeral shaft fractures and is classified into primary RNP and secondary RNP ( 3 ). Primary RNP refers to nerve injuries potentially induced by localized compression at the fracture site, transverse disruption of fracture fragments, or local swelling at the moment of the fracture ( 4 ).…”