Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Aug 25;14(3):37575.
doi: 10.52965/001c.37575. eCollection 2022.

WHICH SURGICAL TREATMENT IS PREFERABLE IN HUMERAL DIAPHYSEAL FRACTURES? A SYSTEMATIC REVIEW

Michela Saracco  1 , Camillo Fulchignoni  1 , Fabrizio Fusco  2 , Giandomenico Logroscino  3
Affiliations

WHICH SURGICAL TREATMENT IS PREFERABLE IN HUMERAL DIAPHYSEAL FRACTURES? A SYSTEMATIC REVIEW

Michela Saracco et al. Orthop Rev (Pavia). .

Abstract

Introduction: Humeral diaphyseal fractures are very common. Many treatments have been proposed but the choice of the best one is often complex.

Objective: The aim of the proposed study is to analyze the data in the literature in order to define the risks, advantages and disadvantages of the alternative surgical treatments (anterograde/retrograde intramedullary nailing, ORIF, MIPO).

Methods: PubMed / Medline and Google Scholar were searched for prospective randomized or case-control retrospective studies about surgical treatment of humeral diaphyseal fractures with nailing, ORIF and MIPO, according to PRISMA guidelines. The primary outcome considered was the fracture healing time by comparing nailing-ORIF, nailing-MIPO and ORIF-MIPO. Differences in the rate of post-operative complications, patient satisfaction, intra-operative blood loss and surgical time were considered secondary outcomes.

Results: 506 studies were identified, but only 10 studies were valid for the systematic review. No differences between nailing, ORIF and MIPO were recorded in terms of healing and surgical times. Intra-operative blood loss was significantly higher during ORIF (p 0.024). No differences were found in the restoration of function evaluated using clinical scales. The rate of complications was 27.4% for nailing, 21.2% for ORIF and 13.8% for MIPO. The difference was statistically significant only by comparing nailing with MIPO (p 0.012), probably because anterograde nailing is more often correlated to shoulder impairment. ORIF was at higher risk of infection compared to nailing (p 0.007).

Conclusion: Humeral diaphyseal fractures require careful pre-operative planning, ensuring reduced healing time, less soft tissue damage and low rate of complications. The lower exposure of the fracture allows for excellent results with reduced bleeding and lower risk of complications.

Keywords: ORIF; ORIF and MIPO; nailing-MIPO and ORIF-MIPO.

PubMed Disclaimer

Conflict of interest statement

Authors declare that they have no conflict of interest to disclosure.

Figures

Figure 1.
Figure 1.. Flow diagram of our systematic review according to PRISMA guidelines.
Figure 2.
Figure 2.. Risk of bias summary: authors’ judgement about each domain for each study included.
Figure 3.
Figure 3.. Risk of bias graph: authors’ judgement about each domain presented as percentages across included studies.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. 1. van de Wall BJM, Ochen Y, Beeres FJP, et al. Conservative vs. operative treatment for humeral shaft fractures: a meta-analysis and systematic review of randomized clinical trials and observational studies. J Shoulder Elbow Surg. 2020;29(7):1493-1504. doi:10.1016/j.jse.2020.01.072 - PubMed
    1. 2. Schoch BS, Padegimas EM, Maltenfort M, Krieg J, Namdari S. Humeral shaft fractures: national trends in management. J Orthop Traumatol. 2017;18(3):259-263. doi:10.1007/s10195-017-0459-6 - PMC - PubMed
    1. 3. Tricco AC, Lillie E, Zarin W, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018;169(7):467-473. doi:10.7326/m18-0850 - PubMed
    1. 4. Akalın Y, Şahin İG, Çevik N, Güler BO, Avci Ö, Öztürk A. Locking compression plate fixation versus intramedullary nailing of humeral shaft fractures: which one is better? A single-centre prospective randomized study. Int Orthop. 2020;44(10):2113-2121. doi:10.1007/s00264-020-04696-6 - PubMed
    1. 5. Benegas E, Ferreira Neto AA, Gracitelli MEC, et al. Shoulder function after surgical treatment of displaced fractures of the humeral shaft: a randomized trial comparing antegrade intramedullary nailing with minimally invasive plate osteosynthesis. J Shoulder Elbow Surg. 2014;23(6):767-774. doi:10.1016/j.jse.2014.02.010 - PubMed