Plating versus Intramedullary Nailing of Humeral Shaft Fractures in Adults: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

LI Lianhua ,  SUN Tiansheng , LIU Zhi , GUO Yongzhi , LI Shaoguang , QIN Chongchong

Department of Orthopedics, General Hospital of Beijing Military Area Command of Chinese PLA, Beijing 100700, China;

Corresponding author：

SUN Tiansheng, Email: lilianhua@medmail.com.cn

Keywords：

Humeral shaft fracture; Fracture fixation; Intramedullary nailing; Plating; Randomized controlled trial; Systematic review

DOI：

10.7507/1672-2531.20080149

Video：

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Objective 　To compare the efficacy of plating versus intramedullary nailing in the treatment of adult humeral shaft fracture.
Methods 　We identified eligible studies in PubMed (1950 to September 2007), MEDLINE (1950 to September 2007), OVID CINAHL (1950 to September 2007), OVID EBM (3rd Quarter 2007), CBMdisk (1978 to June 2007) and CNKI (1981 to June 2007). We also handsearched several Chinese orthopedic journals. Data were extracted and evaluated by two reviewers independently. Randomized controlled trials (RCTs) comparing plating versus intramedullary nailing for humeral shaft fracture in adults were included and the quality of these trials was critically assessed. Data analyses were conducted with Stata 10.0.
Results 　Six RCTs involving 425 patients were included, among which the statistical heterogeneity was not significant (P gt;0.1). Cumulative meta-analyses showed that intramedullary nailing might increase the re-operation rate in studies conducted before the year of 2000 (OR=0.39, 95%CI 0.17 to 0.90, P=0.03), but the difference was not significant in studies conducted after 2000 (OR=0.54, 95%CI 0.27 to 1.08, P=0.08). Intramedullary nailing might increase the incidence of shoulder impingement compared with plating (OR=0.13, 95%CI 0.03 to 0.65, P=0.01). The rates of non-union, deep infection, iatrogenic radial nerve injury and internal fixation failure were similar between plating and intramedullary nailing. Meta-analyses were not conducted for union time, operation time and bleeding (transfusion) volume, because the relevant data were not available from the included trials.
Conclusion 　Intramedullary nailing may increase the incidence of shoulder impingement. The rates of re-operation, non-union, deep infection, iatrogenic radial nerve injury and internal fixation failure are similar between plating and intramedullary nailing. Further well-designed and large-scale randomized controlled trials are required to determine the effects of plating and intramedullary nailing on these outcomes.

Citation： LI Lianhua,SUN Tiansheng,LIU Zhi,GUO Yongzhi,LI Shaoguang,QIN Chongchong. Plating versus Intramedullary Nailing of Humeral Shaft Fractures in Adults: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2008, 08(8): 662-667. doi: 10.7507/1672-2531.20080149 Copy

1.	Pollock AH, Drake D, Bovill EG. Treatment of radial neuropathy associated with fractures of the humerus. J Bone Joint Surg (Am), 1981, 63(2): 239-243.
2.	Bell MJ, Beauchamp CG, Kellam JK, et al. The results of plating humeral shaft fractures in patients with multiple injuries: the Sunnybrook experience. J Bone Joint Surg (Br), 1985, 67(2): 293-296.
3.	Brumback RJ, Bosse MJ, Poka A, et al. Intramedullary stabilisation of humerus shaft fractures in patients with multiple trauma. J Bone Joint Surg (Am), 1986, 68(7): 960-970.
4.	Amillo S, Barrios RH, Martinez-Peric R. Surgical treatment of the radial nerve lesions associated with fractures of the humerus. J Orthop Trauma, 1993, 7(3): 211-215.
5.	Foster RJ, Swiontkowski MF, Bach AW. Radial nerve palsy caused by open humeral shaft fractures. J Hand Surg, 1993, 18A(1): 121-124.
6.	Robinson CM, Bell KM, Court-Brown CM, et al. Locked nailing of humeral shaft fractures. J Bone Joint Surg (Br), 1992, 74(4): 558-562.
7.	Kurup H, Hossain M, Andrew JG. Plating versus intramedullary nailing for humeral shaft fractures in adults. Cochrane Database of Systematic Reviews, 2007, Issue 3.
8.	Breslow NE, Day DE. Combination of results from a series of 2 x 2 tables; control of confounding. In: Statistical methods in cancer research. Vol. 1. The analysis of case-control studies. Lyon, France: International Agency for research on cancer, 1980, 136-146.
9.	Bhandari M, Devereaux PJ, McKee MD, et al. Compression plating versus intramedullary nailing of humeral shaft fractures—a meta-analysis. Acta Orthop, 2006, 77(2): 279-284.
10.	李斌, 白靖平, 吴泰相. 髓内针固定与钢板内固定比较治疗成人肱骨干骨折的系统评价. 中国循证医学杂志, 2006, 6(10): 705-711.
11.	Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ, 1997, 315(7109): 629-634.
12.	Kesemenli CC, Subasi M, Arslan H, et al. Comparison between the results of intramedullary nailing and compression plate fixation in the treatment of humerus fractures. Acta Orthop Traumatol Turc, 2003, 37(2): 120-125.
13.	Meekers FS, Broos PL. Operative treatment of humeral shaft fractures. The Leuven experience. Acta Orthop Belg, 2002, 68(5): 462-470.
14.	Lin J. Treatment of Humeral Shaft Fractures with Humeral Locked Nail and Comparison with Plate Fixation. J Trauma, 1998, 44(5): 859-864.
15.	Flinkkila T, Hyvonen P, Siira P, et al. Recovery of shoulder joint function after humeral shaft fracture: a comparative study between antegrade intramedullary nailing and plate fixation. Arch Orthop Trauma Surg, 2004, 124(8): 537-541.
16.	Chao TC, Chou WY, Chung JC, et al. Humeral shaft fractures treated by dynamic compression plates, Ender nails and interlocking nails. Int Orthop, 2005, 29(2): 88-91.
17.	Rodrigues-Merchan EC. Compression plating versus hackethal nailing in closed humeral shaft fractures failing nonoperative reduction. J Orthop Trauma, 1995, 9(3): 194-197.
18.	Chiu FY, Chen CM, Lin CF, et al. Closed Humeral Shaft Fractures: A Prospective Evaluation of Surgical Treatment. Journal of Trauma-Injury Infection & Critical Care, 1997, 43(6): 947-951.
19.	Chapman JR, Henley MB, Agel J, et al. Randomized prospective study of humeral shaft fracture fixation: Intramedullary nails versus plates. J Orthop Trauma, 2000, 14(3): 162-166.
20.	McCormack RG, Brien D, Buckley RE, et al. Fixation of fractures of the shaft of the humerus by dynamic compression plate or intramedullary nail: A prospective randomized trial. J Bone Joint Surg (Br), 2000, 82(7): 336-339.
21.	Changulani M, Jain UK, Keswani T. Comparison of the use of the humerus intramedullary nail and dynamic compression plate for the management of diaphyseal fractures of the humerus. A randomised controlled study. Int Orthop, 2007, 31(3): 391-395.
22.	Daglar B, Delialioglu OM, Tasbas BA, et al. Comparison of plate-screw fixation and intramedullary fixation with inflatable nails in the treatment of acute humeral shaft fractures. Acta Orthop Traumatol Turc, 2007, 41(1): 7-14.

1. Pollock AH, Drake D, Bovill EG. Treatment of radial neuropathy associated with fractures of the humerus. J Bone Joint Surg (Am), 1981, 63(2): 239-243.
2. Bell MJ, Beauchamp CG, Kellam JK, et al. The results of plating humeral shaft fractures in patients with multiple injuries: the Sunnybrook experience. J Bone Joint Surg (Br), 1985, 67(2): 293-296.
3. Brumback RJ, Bosse MJ, Poka A, et al. Intramedullary stabilisation of humerus shaft fractures in patients with multiple trauma. J Bone Joint Surg (Am), 1986, 68(7): 960-970.
4. Amillo S, Barrios RH, Martinez-Peric R. Surgical treatment of the radial nerve lesions associated with fractures of the humerus. J Orthop Trauma, 1993, 7(3): 211-215.
5. Foster RJ, Swiontkowski MF, Bach AW. Radial nerve palsy caused by open humeral shaft fractures. J Hand Surg, 1993, 18A(1): 121-124.
6. Robinson CM, Bell KM, Court-Brown CM, et al. Locked nailing of humeral shaft fractures. J Bone Joint Surg (Br), 1992, 74(4): 558-562.
7. Kurup H, Hossain M, Andrew JG. Plating versus intramedullary nailing for humeral shaft fractures in adults. Cochrane Database of Systematic Reviews, 2007, Issue 3.
8. Breslow NE, Day DE. Combination of results from a series of 2 x 2 tables; control of confounding. In: Statistical methods in cancer research. Vol. 1. The analysis of case-control studies. Lyon, France: International Agency for research on cancer, 1980, 136-146.
9. Bhandari M, Devereaux PJ, McKee MD, et al. Compression plating versus intramedullary nailing of humeral shaft fractures—a meta-analysis. Acta Orthop, 2006, 77(2): 279-284.
10. 李斌, 白靖平, 吴泰相. 髓内针固定与钢板内固定比较治疗成人肱骨干骨折的系统评价. 中国循证医学杂志, 2006, 6(10): 705-711.
11. Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ, 1997, 315(7109): 629-634.
12. Kesemenli CC, Subasi M, Arslan H, et al. Comparison between the results of intramedullary nailing and compression plate fixation in the treatment of humerus fractures. Acta Orthop Traumatol Turc, 2003, 37(2): 120-125.
13. Meekers FS, Broos PL. Operative treatment of humeral shaft fractures. The Leuven experience. Acta Orthop Belg, 2002, 68(5): 462-470.
14. Lin J. Treatment of Humeral Shaft Fractures with Humeral Locked Nail and Comparison with Plate Fixation. J Trauma, 1998, 44(5): 859-864.
15. Flinkkila T, Hyvonen P, Siira P, et al. Recovery of shoulder joint function after humeral shaft fracture: a comparative study between antegrade intramedullary nailing and plate fixation. Arch Orthop Trauma Surg, 2004, 124(8): 537-541.
16. Chao TC, Chou WY, Chung JC, et al. Humeral shaft fractures treated by dynamic compression plates, Ender nails and interlocking nails. Int Orthop, 2005, 29(2): 88-91.
17. Rodrigues-Merchan EC. Compression plating versus hackethal nailing in closed humeral shaft fractures failing nonoperative reduction. J Orthop Trauma, 1995, 9(3): 194-197.
18. Chiu FY, Chen CM, Lin CF, et al. Closed Humeral Shaft Fractures: A Prospective Evaluation of Surgical Treatment. Journal of Trauma-Injury Infection & Critical Care, 1997, 43(6): 947-951.
19. Chapman JR, Henley MB, Agel J, et al. Randomized prospective study of humeral shaft fracture fixation: Intramedullary nails versus plates. J Orthop Trauma, 2000, 14(3): 162-166.
20. McCormack RG, Brien D, Buckley RE, et al. Fixation of fractures of the shaft of the humerus by dynamic compression plate or intramedullary nail: A prospective randomized trial. J Bone Joint Surg (Br), 2000, 82(7): 336-339.
21. Changulani M, Jain UK, Keswani T. Comparison of the use of the humerus intramedullary nail and dynamic compression plate for the management of diaphyseal fractures of the humerus. A randomised controlled study. Int Orthop, 2007, 31(3): 391-395.
22. Daglar B, Delialioglu OM, Tasbas BA, et al. Comparison of plate-screw fixation and intramedullary fixation with inflatable nails in the treatment of acute humeral shaft fractures. Acta Orthop Traumatol Turc, 2007, 41(1): 7-14.

Chinese Journal of Evidence-Based Medicine

Plating versus Intramedullary Nailing of Humeral Shaft Fractures in Adults: A Systematic Review

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