Amer Kamil M, Kurland Adam M, Smith Brendan, Abdo Zuhdi, Amer Rami, Vosbikian Michael M, Ahmed Irfan H
1 Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
2 Department of Orthopedic Surgery, St. Luke's University Health Network, Bethlehem, PA, USA.
Arch Bone Jt Surg. 2022 Aug;10(8):661-667. doi: 10.22038/ABJS.2021.59413.2947.
The two techniques most utilized in the surgical treatment of humeral shaft fractures are open reduction internal fixation (ORIF) and intramedullary nailing (IMN). Although there have been multiple comparative clinical studies comparing outcomes for these two treatments, studies have not suggested one approach to be superior to the other. The purpose of this study is to perform a systematic literature review and meta-analysis of studies that evaluated the treatment of humeral shaft fractures with either ORIF or intramedullary nail.
We conducted this meta-analysis utilizing stricter inclusion and broader exclusion criteria to examine these two common approaches. We examined those articles which have compared first-time, closed fractures of the humeral diaphysis in adults in fracture patterns that could be treated equivalently by intramedullary nail or plate fixation. The primary outcome of interest was nonunion, and studies that did not report nonunion rates were excluded.
There were a total of 1,926 abstracts reviewed and a total of three articles were included in the final analysis after screening. There was no significant difference in the incidence of nonunion between plating (2/111, 1.8%) and nailing (4/104, 3.9%) (). The mean difference in average time to union for plated fractures and nailed fractures was 1.11 weeks (95% CI 0.82 to 1.40) which was statistically significant (). There was a significant difference in the incidence of radial nerve palsy (12/111, 10.8%) for plating compared to nailing (0/104, 0%) (). There was no difference in incidence of post-operative infection between the two groups intramedullary nailing ().
The results of this analysis demonstrate an increased risk of iatrogenic radial nerve injury, and a significantly shorter time to union when treating humeral shaft fractures with plating as compared to intramedullary nailing. There was no difference in the rates of nonunion or delayed union. Based on the evidence, both plating and nailing can achieve a similar treatment effect on humeral shaft fractures.
肱骨干骨折手术治疗中最常用的两种技术是切开复位内固定术（ORIF）和髓内钉固定术（IMN）。尽管已经有多项比较这两种治疗方法疗效的临床研究，但尚未有研究表明一种方法优于另一种。本研究的目的是对评估采用ORIF或髓内钉治疗肱骨干骨折的研究进行系统的文献综述和荟萃分析。
我们采用更严格的纳入标准和更宽泛的排除标准进行这项荟萃分析，以研究这两种常用方法。我们审查了那些比较成人首次闭合性肱骨干骨折的文章，这些骨折的类型可以通过髓内钉或钢板固定进行等效治疗。感兴趣的主要结局是骨不连，未报告骨不连发生率的研究被排除。
共审查了1926篇摘要，经过筛选后，最终分析纳入了3篇文章。钢板固定组（2/111，1.8%）和髓内钉固定组（4/104，3.9%）的骨不连发生率无显著差异（）。钢板固定骨折和髓内钉固定骨折的平均愈合时间差异为1.11周（95%CI 0.82至1.40），具有统计学意义（）。钢板固定组的桡神经麻痹发生率（12/111，10.8%）与髓内钉固定组（0/104，0%）相比有显著差异（）。两组的术后感染发生率无差异（髓内钉固定组）。
本分析结果表明，与髓内钉固定相比，采用钢板固定治疗肱骨干骨折时，医源性桡神经损伤风险增加，愈合时间显著缩短。骨不连或延迟愈合率无差异。基于现有证据，钢板固定和髓内钉固定对肱骨干骨折均可取得相似的治疗效果。
