Lunn Kiera, Hurley Eoghan T, Adu-Kwarteng Kwabena, Welch Jessica M, Levin Jay M, Anakwenze Oke, Boachie-Adjei Yaw, Klifto Christopher S
School of Medicine, Duke University, Durham, NC, USA.
Department of Orthopaedic Surgery, Duke University, Durham, NC, USA.
J Shoulder Elbow Surg. 2025 Feb;34(2):626-638. doi: 10.1016/j.jse.2024.07.049. Epub 2024 Sep 25.
The purpose of this study was to systematically review complications arising from intramedullary nailing (IMN) of proximal and humeral shaft fractures. This study hypothesized that there would be a low rate of complications and revision among patients treated with IMN for humerus fractures.
Two independent reviewers performed a literature search in the PubMed database based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were included if they reported on outcomes following the use of intramedullary nails for proximal humerus fractures or humeral shaft fractures. Variables that were collected included complications, visual analog scale pain scores and revision operations.
Overall, 179 studies met the inclusion criteria, with 7984 shoulders. The average age of patients in this study was 55.2 years and 60.7% of patients were female. The mean follow-up was 16.6 months. The overall complication rate for all fractures treated with intramedullary nails was 18.9%, and the overall revision rate was 6.8%. Among the complications were fracture complications (7.5%), hardware complications (7.2%), soft tissue complications (1.8%), neurovascular complications (1.6%), and infection (0.8%). Four-part proximal humerus fractures (52.9%) and open fractures (36.7%) had the highest rates of complication. Among the reasons for revision were hardware removal or replacement (5.0%), conversion to arthroplasty (0.6%), and other (1.2%). The mean visual analog scale pain score at last follow-up was 1.6.
Overall, there was a moderate rate of complications but low rate of revision following IMN of humerus fractures. Open fractures and 4-part proximal humerus fractures had the highest complication rates.
本研究旨在系统回顾肱骨近端和肱骨干骨折髓内钉固定术（IMN）引起的并发症。本研究假设，接受IMN治疗肱骨骨折的患者并发症和翻修率较低。
两名独立评审员根据系统评价和Meta分析的首选报告项目指南在PubMed数据库中进行文献检索。如果研究报告了使用髓内钉治疗肱骨近端骨折或肱骨干骨折后的结果，则纳入研究。收集的变量包括并发症、视觉模拟评分疼痛评分和翻修手术。
总体而言，179项研究符合纳入标准，共涉及7984例肩部病例。本研究中患者的平均年龄为55.2岁，60.7%为女性。平均随访时间为16.6个月。所有接受髓内钉治疗的骨折总体并发症发生率为18.9%，总体翻修率为6.8%。并发症包括骨折并发症（7.5%）、内固定物并发症（7.2%）、软组织并发症（1.8%）、神经血管并发症（1.6%）和感染（0.8%）。肱骨近端四部分骨折（52.9%）和开放性骨折（36.7%）的并发症发生率最高。翻修的原因包括取出或更换内固定物（5.0%）、转换为关节成形术（0.6%）和其他原因（1.2%）。最后一次随访时的平均视觉模拟评分疼痛评分为1.6。
总体而言，肱骨骨折IMN术后并发症发生率中等，但翻修率较低。开放性骨折和肱骨近端四部分骨折的并发症发生率最高。
