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Meta-Analysis
. 2019 Nov;98(46):e17952.
doi: 10.1097/MD.0000000000017952.

Antegrade intramedullary nail versus plate fixation in the treatment of humeral shaft fractures: An update meta-analysis

Hongjie Wen  1 , Shouyan Zhu  2 , Canzhang Li  1 , Zhong Chen  1 , Huagang Yang  1 , Yongqing Xu  3
Affiliations
Meta-Analysis

Antegrade intramedullary nail versus plate fixation in the treatment of humeral shaft fractures: An update meta-analysis

Hongjie Wen et al. Medicine (Baltimore). 2019 Nov.

Abstract

Background: There is no consensus regarding the surgical treatment of humeral shaft fracture. The present meta-analysis was performed to compare the efficacy and safety between antegrade intramedullary nailing (IMN) and plating for humeral shaft fracture.

Methods: PubMed, MEDLINE, Cochrane Library, EMBASE, Clinical Trails, Ovid, ISI Web of Science, and Chinese databases including WanFang Data, China National Knowledge Infrastructure were searched through March 10, 2019. The Review Manager software was adapted to perform statistical analysis and relative risk (RR) were used for the binary variables, and weighted mean difference and standardized mean difference (SMD) were used to measure the continuous variables. Each variable included its 95% confidence interval (CI).

Results: A total of 15 trials with 839 patients were included in the analysis. There was significant difference between IMN group and plate group in blood loss (SMD = 3.49, 95% CI: 1.19, 5.79, P = .003) and postoperative infections (RR = 3.04, 95% CI: 1.49, 6.24, P = .002). Additionally, significant difference was observed between minimally invasive plate osteosynthesis (MIPO) group and IMN group in nonunion rate (RR = 3.20, 95% CI: 0.12, 0.84, P = .02). Statistical significance was also observed between the open reduction plate fixation group and IMN group in restriction of shoulder and elbow joints results (RR = 0.49, 95% CI: 0.26, 0.96, P < .05). No significant difference was observed for the operation time, American Shoulder and Elbow Surgeons score, nerve injury, delayed union, reoperation in either group.

Conclusion: IMN may be superior to plate in reducing blood loss and postoperative infections for the treatment of humeral shaft fracture. However, MIPO was superior to IMN group in nonunion and equal to IMN in other parameters. Further research is required and future studies should include analysis of assessments at different stages and follow-up after removal of the implants.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
The study selection and inclusion process.
Figure 2
Figure 2
Methodological quality of the included studies and risk of bias.
Figure 3
Figure 3
Forest plot for meta-analysis of operation time between the plate and IMN groups.
Figure 4
Figure 4
Forest plot for meta-analysis of blood loss between the plate and IMN groups.
Figure 5
Figure 5
Forest plot for meta-analysis of ASES score between the plate and IMN groups.
Figure 6
Figure 6
Forest plot for meta-analysis of nonunion rate between the plate and IMN groups.
Figure 7
Figure 7
Forest plot for meta-analysis of nerve injury between the plate and IMN groups.
Figure 8
Figure 8
Forest plot for meta-analysis of postoperative infections between the plate and IMN groups.
Figure 9
Figure 9
Forest plot for meta-analysis of reoperation between the plate and IMN groups.
Figure 10
Figure 10
Forest plot for meta-analysis of delayed union between the plate and IMN groups.
Figure 11
Figure 11
Forest plot for meta-analysis of restriction of shoulder and elbow joints between the plate and IMN groups.
Figure 12
Figure 12
Funnel plot of the nonunion rate between the plate and IMN groups. RR = relative risk, SE = standard error.
See this image and copyright information in PMC

References

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