Minimally invasive plate osteosynthesis vs conventional fixation techniques for surgically treated humeral shaft fractures: a meta-analysis

Hu, Xianluo; Xu, Siqi; Lu, Huigen; Bao, Changchun; Zhou, Xiao; He, Xiaojun; Dai, Jingxing; Zhang, Zhongwei; Gong, Shusheng

doi:10.1186/s13018-016-0394-x

Cited by 42 publications

(29 citation statements)

References 31 publications

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“…First, this study can be considered the first network meta-analysis of a randomized trial that evaluates the surgical procedures for humeral shaft fractures. Although several meta-analyses regarding this title have been published, [12, 13, 38] none are network meta-analyses. Second, a major strength of present study is that all of the included studies used a randomized controlled design, which increases the comparability between the two groups and reduces the probability of selection bias.…”

Section: Discussionmentioning

confidence: 99%

Surgical interventions to treat humerus shaft fractures: A network meta-analysis of randomized controlled trials

et al. 2017

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BackgroundThere are three main surgical techniques to treat humeral shaft fractures: open reduction and plate fixation (ORPF), intramedullary nail (IMN) fixation, and minimally invasive percutaneous osteosynthesis (MIPO). We performed a network meta-analysis to compare three surgical procedures, including ORPF, IMN fixation, and MIPO, to provide the optimum treatment for humerus shaft fractures.MethodsMEDLINE, EMBASE, Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, and Cochrane library were researched for reports published up to May 2016. We only included randomized controlled trials (RCTs) comparing two or more of the three surgical procedures, including the ORPF, IMN, and MIPO techniques, for humeral shaft fractures in adults. The methodological quality was evaluated based on the Cochrane risk of bias tool. We used WinBUGS1.4 to conduct this Bayesian network meta-analysis. We used the odd ratios (ORs) with 95% confidence intervals (CIs) to calculate the dichotomous outcomes and analyzed the percentages of the surface under the cumulative ranking curve.ResultsSeventeen eligible publications reporting 16 RCTs were included in this study. Eight hundred and thirty-two participants were randomized to receive one of three surgical procedures. The results showed that shoulder impingement occurred more commonly in the IMN group than with either ORPF (OR, 0.13; 95% CI, 0.03–0.37) or MIPO fixation (OR, 0.08; 95% CI, 0.00–0.69). Iatrogenic radial nerve injury occurred more commonly in the ORPF group than in the MIPO group (OR, 11.09; 95% CI, 1.80–124.20). There were no significant differences among the three procedures in nonunion, delayed union, and infection.ConclusionCompared with IMN and ORPF, MIPO technique is the preferred treatment method for humeral shaft fractures.

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Section: Discussionmentioning

confidence: 99%

Surgical interventions to treat humerus shaft fractures: A network meta-analysis of randomized controlled trials

et al. 2017

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“…Good clinical outcomes are generally achieved with intramedullary nailing as well as with plating. A recent meta-analysis showed an advantage for anterior Minimally Invasive Plate Osteosynthesis (MIPO technique with inserted 4.5 mm LCP) with regard to postoperative complications [31]. However, DP with a distal humeral plate and an additional reconstruction plate via a posterior approach can also achieve good clinical outcomes [32].…”

Section: Humeral Shaftmentioning

confidence: 99%

Biomechanics of Upper Extremity Double Plating

et al. 2019

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Double plating (DP) is an established treatment modality in traumatology. For certain indications, such as open reduction and internal fixation of bicondylar tibial plateau fractures and distal humeral fractures, DP is standard of care in the clinical routine. However, the principles of DP can be transferred to other anatomic regions and indications. In the past years, DP has been brought more and more into focus. For revision cases, such as the treatment of fracture non-unions, DP seems generally useful. In anatomical locations with high torsional stress and bending forces, but also in regions with traction forces by muscles and tendons DP provides multiplanar stability and therefore seems to have biomechanical advantages. Usually two smaller implants can replace one larger implant. Thus, the number of points of fixation can be increased, the stability can be improved and soft-tissue irritations by bulky implants can be minimized. Along with the established indication and application at the distal humerus, there is biomechanical evidence in the current literature for DP of clavicle fractures and humeral shaft fractures. Furthermore, DP provides mechanical advantages in the treatment of certain proximal humeral fractures and olecranon fractures. This review of the literature summarizes the published literature on biomechanics of upper extremity DP.

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“…The minimally invasive technique has also found its place for its minor soft tissue injury during the procedure, 17 despite the concern regarding deformities resulting from an inadequate reduction of the fracture and safety for the radial nerve. 18 In the current study, similar non-consolidation rates were observed between the ORIF with plate and screws group and the bridge plating group (10.3% and 8.9%, respectively), which is in agreement with the literature findings.…”

Section: Discussionmentioning

confidence: 99%

“… 18 In the current study, similar non-consolidation rates were observed between the ORIF with plate and screws group and the bridge plating group (10.3% and 8.9%, respectively), which is in agreement with the literature findings. 17 , 18 Both groups presented the same number (two) of patients with radial nerve praxia after the procedure that had not been identified on admission. In their meta-analysis, Hu et al 17 demonstrated a statistically significant difference in radial nerve injury after the procedure, higher in the group of conventional osteosynthesis with ORIF with plate and screws.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the surgical treatment of humeral shaft fractures and comparison between surgical fixation methods

Gonçalves

Dau²,

Grassi³

et al. 2018

Revista Brasileira de Ortopedia (English Edition)

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ObjectiveThe objective of this study is to analyze the surgical results of humeral shaft fracture treatment and describe its epidemiology.MethodsRetrospective study that identified all patients treated with surgical fixation of humeral shaft fractures between December of 2014 and June of 2016 in a trauma reference center. All medical records were reviewed in search of epidemiological data referent to the trauma and post-operative results, including radiographic healing of the fracture and related complications.ResultsFifty-one patients were included, mostly male (78.4%), with an average age of 35.02 years. The most common trauma mechanism was a traffic accident (56.9%) followed by same-level falls (17.6%). No statistically significant difference was found between healing time comparing surgical fixation techniques, including open reduction and internal fixation, minimally invasive technique, intramedullary nailing, and external fixation.ConclusionAlthough each technique has inherent advantages and disadvantages, all fixation methods proved to be adequate options for the surgical treatment of humeral shaft fractures with high rates of healing and low rates of post-operative complications.

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Minimally invasive plate osteosynthesis vs conventional fixation techniques for surgically treated humeral shaft fractures: a meta-analysis

Cited by 42 publications

References 31 publications

Surgical interventions to treat humerus shaft fractures: A network meta-analysis of randomized controlled trials

Surgical interventions to treat humerus shaft fractures: A network meta-analysis of randomized controlled trials

Biomechanics of Upper Extremity Double Plating

Evaluation of the surgical treatment of humeral shaft fractures and comparison between surgical fixation methods

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