Intramedullary Nailing or Compression Plates for Humeral Shaft Fractures in Adults: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

LI Bin ¹ , BAI Jingping ² , WU Taixiang ³

1. Postgraduate2003, XingJing Medical University, Urimqi 830054, China2. The Third Affiliated Hospital of XinJing Medical University, Urimqi 830054, China3. Chinese Evidence-based Medicine Center/Clinical Epidemiology Resource and Training Center,West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

Keywords：

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

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Objective 　To determine the efficacy and complication rate of intramedullary nailing versus compression plate in the treatment of adult humeral shaft fracture.
Methods 　We searched the specialized trials register of The Cochrane Collaboration’s Bone, Joint and Muscle Trauma Group, The Cochrane Library (including CENTRAL), MEDLINE (1966 to 2006), EMbase (1980 to 2006), PubMed (1966 to 2006), NRR , CCT and CBMdisc (1979 to July 2006). We also handsearched some Chinese orthopedic journals. Data were extracted and evaluated by two reviewers independently. Randomize controlled trials comparing intramedullary nailing versus compression plate for humeral shaft fracture in adults were included and the quality of these trials was critically assessed. Data analyses were done using The Cochrane Collaboration’s RevMan 4.2.8.
Results 　Three randomize controlled trials involving 215 patients were included. The meta-analysis showed that intramedullary nailing may increase the re-operation rate (OR=2.68, 95%CI 1.19 to 6.04, P=0.02), pain in the shoulder (OR=13.02, 95%CI 2.23 to 75.95, P=0.004), and the rate of decreased range of motion of the shoulder (OR=18.60, 95%CI 1.01 to 341.83, P=0.05). The rates of no union, infection and iatrogenic radial nerve injury were comparable between intramedullary nailing and compression plate. Meta-analysis was not conducted for the time of union, because the relevant data were not available for the included trials.
Conclusions 　Further well-designed and large-scale randomize controlled trials are required to determine the effects of intramedullary nailing and compression plate on these outcomes, because the trials available for this systematic review are too few and too small.

Citation： LI Bin,BAI Jingping,WU Taixiang. Intramedullary Nailing or Compression Plates for Humeral Shaft Fractures in Adults: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2006, 06(10): 705-711. doi: Copy

1.	倪东亮,祝云利,林平.钢板及交锁髓内钉治疗肱骨干骨折疗效对比.中国矫形外科杂志, 2000; 7(12): 1 167–1 169.
2.	Zagorski JB, Latta LL, Zych GA, et al.Diaphyseal fractures of the humerus. Treatment with prefabricated braces. J Bone Joint Surg Am, 1988; 70(4): 607–610.
3.	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.
4.	Christensen NO.Kuntscher intramedullary reaming and nail fixation for nonunion of the humerus. Clin Orthop Relat Res, 1976; (116): 222–225.
5.	Vander Griend R, Tomasin J, Ward EF. Open reduction and internal fixation of humeral shaft fractures. Results using AO plating techniques. J Bone Joint Surg Am, 1986; 68(3): 430–433.
6.	Modabber MR, Jupiter JB. Operative management of diaphyseal fractures of the humerus. Plate versus nail. Clin Orthop Relat Res, 1998; (347): 93–104.
7.	DeLong WG Jr, Born CT, Marcelli E, et al. Ender nail fixation in long bone fractures: experience in a level I trauma center. J Trauma, 1989; 29(5): 571–576.
8.	Durbin RA, Gottesman MJ, Saunders KC. Hackethal stacked nailing of humeral shaft fractures. Experience with 30 patients. Clin Orthop Relat Res, 1983; (179): 168–174.
9.	Hall RF Jr, Pankovich AM. Ender nailing of acute fractures of the humerus. A study of closed fixation by intramedullary nails without reaming. J Bone Joint Surg Am, 1987; 69(4): 558–567.
10.	Chiu FY, Chen CM, Lin CF, et al. Closed humeral shaft fractures: a prospective evaluation of surgical treatment. J Trauma, 1997; 43(6): 947–951.
11.	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.
12.	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, randomised trial. J Bone Joint Surg Br, 2000; 82(3):336–369.
13.	Henley MB, Chapman JR, Claudi BF. Closed retrograde Hackethal nail stabilization of humeral shaft fractures. J Orthop Trauma, 1992; 6(1): 18–24.
14.	Ruedi T, Moshfegh A, Pfeiffer KM, et al. Fresh fractures of the shaft of the humerus--conservative or operative treatment? Reconstr Surg Traumatol. 1974; 14(0): 65–74.
15.	Chacha PB. Compression plating without bone grafts for delayed and non-union of humeral shaft fractures. Injury, 1974; 5(4): 283–290.
16.	Naiman PT, Schein AJ, Siffert RS. Use of ASIF compression plates in selected shaft fractures of the upper extremity: a preliminary report. Clin Orthop, 1970; 71: 208.
17.	Ni DL,Zhu XL,Ling P. The Comparision between the Effect of Plate and Locked Intramedullary Nailing in the Fracture of Humeral Fracture. The Orthopedic Journal of China, 2000; 7(12): 1 167–1 169.

1. 倪东亮,祝云利,林平.钢板及交锁髓内钉治疗肱骨干骨折疗效对比.中国矫形外科杂志, 2000; 7(12): 1 167–1 169.
2. Zagorski JB, Latta LL, Zych GA, et al.Diaphyseal fractures of the humerus. Treatment with prefabricated braces. J Bone Joint Surg Am, 1988; 70(4): 607–610.
3. 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.
4. Christensen NO.Kuntscher intramedullary reaming and nail fixation for nonunion of the humerus. Clin Orthop Relat Res, 1976; (116): 222–225.
5. Vander Griend R, Tomasin J, Ward EF. Open reduction and internal fixation of humeral shaft fractures. Results using AO plating techniques. J Bone Joint Surg Am, 1986; 68(3): 430–433.
6. Modabber MR, Jupiter JB. Operative management of diaphyseal fractures of the humerus. Plate versus nail. Clin Orthop Relat Res, 1998; (347): 93–104.
7. DeLong WG Jr, Born CT, Marcelli E, et al. Ender nail fixation in long bone fractures: experience in a level I trauma center. J Trauma, 1989; 29(5): 571–576.
8. Durbin RA, Gottesman MJ, Saunders KC. Hackethal stacked nailing of humeral shaft fractures. Experience with 30 patients. Clin Orthop Relat Res, 1983; (179): 168–174.
9. Hall RF Jr, Pankovich AM. Ender nailing of acute fractures of the humerus. A study of closed fixation by intramedullary nails without reaming. J Bone Joint Surg Am, 1987; 69(4): 558–567.
10. Chiu FY, Chen CM, Lin CF, et al. Closed humeral shaft fractures: a prospective evaluation of surgical treatment. J Trauma, 1997; 43(6): 947–951.
11. 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.
12. 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, randomised trial. J Bone Joint Surg Br, 2000; 82(3):336–369.
13. Henley MB, Chapman JR, Claudi BF. Closed retrograde Hackethal nail stabilization of humeral shaft fractures. J Orthop Trauma, 1992; 6(1): 18–24.
14. Ruedi T, Moshfegh A, Pfeiffer KM, et al. Fresh fractures of the shaft of the humerus--conservative or operative treatment? Reconstr Surg Traumatol. 1974; 14(0): 65–74.
15. Chacha PB. Compression plating without bone grafts for delayed and non-union of humeral shaft fractures. Injury, 1974; 5(4): 283–290.
16. Naiman PT, Schein AJ, Siffert RS. Use of ASIF compression plates in selected shaft fractures of the upper extremity: a preliminary report. Clin Orthop, 1970; 71: 208.
17. Ni DL,Zhu XL,Ling P. The Comparision between the Effect of Plate and Locked Intramedullary Nailing in the Fracture of Humeral Fracture. The Orthopedic Journal of China, 2000; 7(12): 1 167–1 169.

Chinese Journal of Evidence-Based Medicine

Intramedullary Nailing or Compression Plates for Humeral Shaft Fractures in Adults: A Systematic Review

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