MIPO versus nailing for humeral shaft fractures: a meta-analysis and systematic review of randomised clinical trials and observational studies

Abstract

Purpose There is no consensus on the optimal operative technique for humeral shaft fractures. This meta-analysis aims to compare minimal-invasive plate osteosynthesis (MIPO) with nail fixation for humeral shaft fractures regarding healing, complications and functional results. Methods PubMed/Medline/Embase/CENTRAL/CINAHL were searched for randomized clinical trials (RCT) and observational studies comparing MIPO with nailing for humeral shaft fractures. Effect estimates were pooled across studies using random effects models and presented as weighted odds ratio (OR), risk difference (RD), mean difference (MD) and standardized mean difference (SMD) with corresponding 95% confidence interval (95%CI). Analyses were repeated stratified by study design (RCTs and observational studies). Results A total of 2 RCTs (87 patients) and 5 observational studies (595 patients) were included. The effects estimated in observational studies and RCTs were similar in direction and magnitude for all outcomes except operation duration. MIPO has a lower risk for non-union (RD 7%; OR 0.2, 95% CI 0.1-0.5) and re-intervention (RD 13%; OR 0.3, 95% CI 0.1-0.8). Functional shoulder (SMD 1.0, 95% CI 0.2-1.8) and elbow scores (SMD 0.4, 95% CI 0-0.8) were better among patients treated with MIPO. The risk for radial nerve palsy following surgery was equal (RD 2%; OR 0.6, 95% CI 0.3-1.2) and nerve function recovered spontaneously in all patients in both groups. No difference was detected with regard to infection, time to union and operation duration. Conclusion MIPO has a considerable lower risk for non-union and re-intervention, leads to better shoulder function and, to a lesser extent, better elbow function compared to nailing. Although nailing appears to be a viable option, the evidence suggests that MIPO should be the preferred treatment of choice. The learning curve of minimal-invasive plating should, however, be taken into account when interpreting these results.

Prevalence and risk factors for pseudarthrosis in humeral shaft fractures treated by minimally invasive plate osteosynthesis: A 10-year review

“…Fractures of the humeral shaft lead to radial nerve damage in 8% to 12% of cases. 11,30 In the present study, radial nerve palsy was found in 14.4% of cases. Despite the higher prevalence of this injury compared to the literature, neurological damage to the radial nerve was not associated with non-union in our cohort.…”

“…Furthermore, the chance of iatrogenic radial nerve lesion after the MIPO is the same or lower than open reduction and internal fixation or intramedullary nailing. 7,10,30 The plate working length is important for MIPO. Giodarno et al 12 reported that a larger plate working length was associated with lower local tension, which could facilitate consolidation through fixation.…”

“…Furthermore, the chance of iatrogenic radial nerve lesion after the MIPO is the same or lower than open reduction and internal fixation or intramedullary nailing. 7,10,30…”

Cement augmentation for trochanteric femur fractures: A meta-analysis of randomized clinical trials and observational studies

“…The mean quality of all studies was 19 points (range 17-21) using the MINOR-Criteria [22]. For randomized controlled studies the mean was 19.5 (range 17-21) and for observational studies the mean was 18.3 (range [18][19]. Details can be seen in S3 Table in S1 File.…”

Current trends in the development of long tubular bones osteosynthesis

“…Отдельные статьи посвящены сравнению МИПО и интрамедуллярному остеосинтезу. Так, в двух рандомизированных клинических исследованиях (суммарно 87 пациентов) и пяти обзорных статьях (суммарно 595 пациентов) МИПО имеет меньший риск несращений и частоту ревизий, а также лучшую функцию плечевого и локтевого суставов [32].…”