Locking compression plate fixation versus intramedullary nailing of humeral shaft fractures: which one is better? A single-centre prospective randomized study

Akalın, Yavuz; Şahin, İsmail Gökhan; Çevik, Nazan; Güler, Burak; Avcı, Özgür; Öztürk, Alpaslan

doi:10.1007/s00264-020-04696-6

Cited by 26 publications

(27 citation statements)

References 36 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%

“…Of 34 studies involving patients treated surgically by different methods, 25 reported outcomes on postoperative radial nerve palsy (8,9,19,20,21,22,24,25,26,29,30,31,32,33,36,37,40,44,46,47,48,52,54,55,57). Eighteen of these studies compared IM with ORIF (19, 20,22,24,25,26,29,30,31,33,36,40,47,48,52,54,55,57), four MIPO with ORIF (21,32,37,46), and another three anterior/anterolateral with posterior surgical approaches to the humeral shaft (8,9,44).…”

Section: Iatrogenic Radial Nerve Palsy 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: Iatrogenic Radial Nerve Palsy Riskmentioning

confidence: 99%

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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“…According to Y. Akalin et al, fractures of the humerus, a common injury presenting to orthopedic surgeons, account for 1 to 3 % of all fractures in the elderly and 4 to 6 % in young patients [1].…”

Section: Introductionmentioning

confidence: 99%

“…McCormack et al, 2000; Putti et al, 2009;Wali et al, 2014;Zhang et al, 2015) from these meta-analyses and conducted quantitative analysis on fracture union, reoperation, and adverse events[1,[9][10][11][12][13][14][15][16][17][18].…”

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confidence: 99%

Результати Лікування Переломів Плечової Кістки При Їх Різній Локалізації (Огляд)

Zazirnyi¹,

Savych²,

Levytskyi³

2022

TRAUMA

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The choice of treatment (open reduction and internal fixation) for a humeral fracture with a plate versus an intramedullary nail is highly debated. We compared outcomes (fracture union, reoperation, and adverse events) of intramedullary nailing and plate fixation in patients with proximal humeral, humeral shaft, and distal humeral fractures. No significant differences were found between intramedullary nailing and plate fixation for fracture union, reoperation, or adverse events in patients with proximal humeral or humeral shaft fractures. There is a scarcity of evidence comparing intramedullary nailing and plating for distal humeral fractures. No recommendations can be given from current evidence. Surgeons may have to continue to use discretion based on their personal preference, experience as well as patient’s characteristics and fracture features before more high-quality evidence is available.

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“…Decision-making implies analysis of several factors depending on the patient (age, activity level) and on the fracture itself (risk of secondary avascular necrosis) [2]. Different conservative techniques have been described including locking plates, nails [3] or Bilboquet device [4]. Locking-screw plating is an established and commonly used treatment for displaced proximal humeral fractures [5].…”

Section: Introductionmentioning

confidence: 99%

Comparison of “Bilboquet” device and locking plate for surgical treatment of proximal humerus complex fractures at two years follow-up

Bismuth

Sautet

Doursounian

et al. 2021

International Orthopaedics (SICOT)

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Purpose Surgical treatment of three or four part fractures of the proximal humerus is complex. Different conservative techniques have been described. The main goal of this study was to compare the clinical and radiological outcomes of Bilboquet and locking plate at two year follow-up. Methods This is a retrospective, comparative study, with a continuous series of 41 patients. Bony fixation was achieved with a Bilboquet device in 22 patients or a locking plate in 19 patients. Patient evaluation included clinical data: shoulder range of motion, Constant-Murley shoulder score and DASH (Disabilities of the Arm, Shoulder and Hand) score, and imaging using standard shoulder X-rays. Results Of the 41 patients included, 1 patient was lost to follow-up in the locking plate group. At a mean follow-up of 24 months patients in Bilboquet group showed a Constant score higher than in locking plate (p = 0.02). Range of motion and DASH score were not significantly different between the two groups. avascular necrosis occured in three patients of Bilboquet group (14%) versus in two patients in the locking plate group (11%) (p > 0.5). Complication and reintervention rate were non-significantly higher in the locking plate group than in the Bilboquet group (37 vs 14%). Conclusion Bilboquet and locking plate give good functional outcomes in complex proximal humerus fractures. However, the Bilboquet device appears to provide better functional results than locking plate at mid-term follow-up.

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Locking compression plate fixation versus intramedullary nailing of humeral shaft fractures: which one is better? A single-centre prospective randomized study

Cited by 26 publications

References 36 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

Результати Лікування Переломів Плечової Кістки При Їх Різній Локалізації (Огляд)

Comparison of “Bilboquet” device and locking plate for surgical treatment of proximal humerus complex fractures at two years follow-up

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