Plate fixation versus nailing for humeral shaft fractures: a meta-analysis and systematic review of randomised clinical trials and obser-vational studies

Objectives This meta-analysis aims to compare open reduction internal fixation with a plate versus nailing for humeral shaft fractures in terms of non-union, re-intervention, radial nerve palsy, time to un-ion, operation duration and functional outcomes. Secondarily, effect estimates from observational studies are compared to estimates of randomised clinical trials (RCT).

Methods PubMed/Medline/Embase/CENTRAL/CINAHL were searched for both RCT’s and observational studies comparing plate fixation with nailing for humeral shaft fractures.

Results and Conclusion A total of nine RCT’s (462 patients) and the sixteen observational studies (4245 patients) were included. The pooled non-union rate did not differ significantly between both treatment groups (risk difference: 0%; OR 0.98, 95%CI 0.68-1.42). More patients treated with nailing required re-intervention (risk difference: 2%; OR 2.11, 95%CI 1.09-4.08) with shoulder impingement being the most predominant indication. More patients treated with pate fixation developed radial nerve palsy compared to nailing (OR 0.43, 95%CI 0.31-0.61). Notably the absolute risk difference is small (2%) and during follow-up the palsy resolved spontaneously in the majority of patients. Nailing lead to a faster time to union (mean difference: 2.5 week, 95%CI 3.1-1.8), lower infection rate (risk difference: 2%, OR 0.48, 95%CI 0.31-0.75) and shorter operation duration (mean differ-ence: 20 minutes, 95%CI 32.0-9.4). Functional scores were comparable in both groups (standard-ised mean difference: -0.13, 95%CI -0.46-0.19). There was no difference between effect esti-mates form observational studies and RCT’s.

There appears to be no difference between plate fixation and nailing for humeral shaft fractures with regard to non-union rate and functional outcome. Patients treated with plate fixation have a higher risk for infection and radial nerve palsy, but lower risk for re-intervention. The absolute differences, however, are small. Nailing does differ significantly from plate fixation in terms of shorter operation duration and time to union. The pooled estimates from randomised clinical tri-als did not differ significantly from estimates obtained from observational studies.

Stichwörter humeral shaft fractures, nailing, nail, plate fixation, ORIF

Publication History

Article published online:
15 October 2020