Affiliation:
1. Departments of Orthopedics, Danzhou People’s Hospital, Danzhou, 571700 Hainan, China
2. Departments of Orthopedics, People’s Hospital of Wanning Hainan, Wanning, 571500 Hainan, China
3. Department of Trauma Surgery, Qionghai People’s Hospital, Qionghai, 571400 Hainan, China
Abstract
Objective. The surgical treatment scheme of humeral shaft fracture is still controversial with no consensus reached. This meta-analysis was aimed at comparing the efficacy and safety of intramedullary nail (IMN) and locking compression plate (LCP) in the treatment of humeral shaft fractures. Methods. PubMed, Medline, Embase, Ovid, Cochrane Library, ISI Web of Science, Clinical Trials, and Chinese databases, including China National Knowledge Infrastructure Project, Wanfang database, and China biomedical abstracts database, were used to search the literature. Review Manager software was employed for statistical analysis and establishing forest and funnel maps. Categorical variables were measured by relative risk (RR), and standardized mean difference (SMD) was used to measure continuous variables. 95% confidence intervals were used for each variable. The modified Jadad scale, Newcastle-Ottawa scale, and Cochrane’s bias risk tools were used to evaluate the bias and risk of eligible studies. Results. A total of 14 studies were included in the analysis with a total of 903 patients with humeral shaft fracture. Significant differences with regard to operation time (
, 95% CI: -2.14, -0.22,
,
), blood loss (
, 95% CI: -4.32, -1.63,
,
), and postoperative infection rate (
, 95% CI: -0.15, 0.68,
,
) were noted between the IMN group and LCP group. In addition, the American Shoulder and Elbow Surgeon (ASES) score (
, 95% CI: -0.44, 0.01,
,
) and the rate of shoulder and elbow function limitation (
, 95% CI: 1.06, 3.33,
,
) between the 2 groups were also statistically significant. There were no significant differences in the rate of radial nerve injury, nonunion, delayed healing, and secondary operation between the two groups. Conclusion. IMN is superior than the LCP in terms of the operation time, intraoperative bleeding, and postoperative infection, suggesting its superiority in the humeral shaft fracture fixation. However, IMN is inferior to LCP in ASES score and shoulder elbow function limitation rate, indicating poor early postoperative functional recovery. More studies are required to evaluate and analyze the clinical efficacy between IMN and LCP regarding long-term function after artificial graft removal.
Funder
Danzhou People’s Hospital
Subject
Applied Mathematics,General Immunology and Microbiology,General Biochemistry, Genetics and Molecular Biology,Modeling and Simulation,General Medicine