Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 4/2022

05-07-2021 | Radial Nerve Palsy | Review Article

Open plate fixation versus nailing for humeral shaft fractures: a meta-analysis and systematic review of randomised clinical trials and observational studies

Authors: Frank Joseph Paulus Beeres, Nicole van Veelen, Roderick Marijn Houwert, Björn Christian Link, Marilyn Heng, Matthias Knobe, Rolf Hendrik Herman Groenwold, Reto Babst, Bryan Joost Marinus van de Wall

Published in: European Journal of Trauma and Emergency Surgery | Issue 4/2022

Login to get access

Abstract

Purpose

This meta-analysis compares open reduction and internal fixation with a plate (ORIF) versus nailing for humeral shaft fractures with regard to union, complications, general quality of life and shoulder/elbow function.

Methods

PubMed/Medline/Embase/CENTRAL/CINAHL was searched for observational studies and randomised clinical trials (RCT). Effect estimates were pooled across studies using random effects models. Results were presented as weighted odds ratio (OR) or risk difference (RD) with corresponding 95% confidence interval (95% CI). Subgroup analysis was performed stratified for study design (RCTs and observational studies).

Results

Eighteen observational studies (4906 patients) and ten RCT’s (525 patients) were included. The pooled effect estimates of observational studies were similar to those obtained from RCT’s. More patients treated with nailing required re-intervention (RD 2%; OR 2.0, 95% CI 1.0–3.8) with shoulder impingement being the most predominant indication (17%). Temporary radial nerve palsy secondary to operation occurred less frequently in the nailing group (RD 2%; OR 0.4, 95% CI 0.3–0.6). Notably, all but one of the radial nerve palsies resolved spontaneously in each groups. Nailing leads to a faster time to union (mean difference − 1.9 weeks, 95% CI − 2.9 to − 0.9), lower infection rate (RD 2%; OR 0.5, 95% CI 0.3–0.7) and shorter operation duration (mean difference − 26 min, 95% CI − 37 to − 14). No differences were found regarding non-union, general quality of life, functional shoulder scores, and total upper extremity scores.

Conclusion

Nailing carries a lower risk of infection, postoperative radial nerve palsy, has a shorter operation duration and possibly a shorter time to union. Shoulder impingement requiring re-intervention, however, is an inherent disadvantage of nail fixation. Notably, absolute differences are small and almost all patients with radial nerve palsy recovered spontaneously. Satisfactory results can be achieved with both treatment modalities.
Appendix
Available only for authorised users
Literature
1.
Ekholm R, Adami J, Tidermark J, Hansson K, Tornkvist H, Ponzer S. Fractures of the shaft of the humerus. An epidemiological study of 401 fractures. J Bone Joint Surg Br. 2006;88(11):1469–73.PubMedCrossRef
2.
van de Wall BJM, Ochen Y, Beeres FJP, Babst R, Link BC, Heng M, et al. Conservative vs. operative treatment for humeral shaft fractures: a meta-analysis and systematic review of randomized clinical trials and observational studies. J Shoulder Elbow Surg. 2020;29:1493–504.PubMedCrossRef
3.
Kurup H, Hossain M, Andrew JG. Dynamic compression plating versus locked intramedullary nailing for humeral shaft fractures in adults. Cochrane Database Syst Rev. 2011;6: CD005959.
4.
Liu GD, Zhang QG, Ou S, Zhou LS, Fei J, Chen HW, et al. Meta-analysis of the outcomes of intramedullary nailing and plate fixation of humeral shaft fractures. Int J Surg. 2013;11(9):864–8.PubMedCrossRef
5.
Ma J, Xing D, Ma X, Gao F, Wei Q, Jia H, et al. Intramedullary nail versus dynamic compression plate fixation in treating humeral shaft fractures: grading the evidence through a meta-analysis. PLoS ONE. 2013;8(12): e82075.PubMedPubMedCentralCrossRef
6.
Qiu H, Wei Z, Liu Y, Dong J, Zhou X, Yin L, et al. A Bayesian network meta-analysis of three different surgical procedures for the treatment of humeral shaft fractures. Medicine (Baltimore). 2016;95(51): e5464.CrossRef
7.
Zhao Y, Wang J, Yao W, Cai Q, Wang Y, Yuan W, et al. Interventions for humeral shaft fractures: mixed treatment comparisons of clinical trials. Osteoporos Int. 2017;28(11):3229–37.PubMedCrossRef
8.
Ochen Y, Beks RB, van Heijl M, Hietbrink F, Leenen LPH, van der Velde D, et al. Operative treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review and meta-analysis. BMJ. 2019;364: k5120.PubMedPubMedCentralCrossRef
9.
Beks RB, Peek J, de Jong MB, Wessem KJP, Oner CF, Hietbrink F, et al. Fixation of flail chest or multiple rib fractures: current evidence and how to proceed. A systematic review and meta-analysis. Eur J Trauma Emerg Surg. 2019;45(4):631–44.PubMedCrossRef
10.
Smeeing DPJ, van der Ven DJC, Hietbrink F, Timmers TK, van Heijl M, Kruyt MC, et al. Surgical versus nonsurgical treatment for midshaft clavicle fractures in patients aged 16 years and older: a systematic review, meta-analysis, and comparison of randomized controlled trials and observational studies. Am J Sports Med. 2017;45(8):1937–45.PubMedCrossRef
11.
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg. 2010;8(5):336–41.PubMedCrossRef
12.
Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA. 2000;283(15):2008–12.PubMedCrossRef
13.
Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and dislocation classification compendium-2018. J Orthop Trauma. 2018;32(Suppl 1):S1–170.PubMedCrossRef
14.
Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg. 2003;73(9):712–6.PubMedCrossRef
15.
Wilson J. Surveillance of surgical site infection in orthopaedic surgery is useful in tackling hospital-acquired infections in England. Euro Surveill. 2005;10(11):E051117.3.PubMed
16.
Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343: d5928.PubMedPubMedCentralCrossRef
17.
Yin P, Mao Z, Zhang L, Tao S, Zhang Q, Liang X, et al. Effectiveness comparison between locking compression plate fixation and locked intramedullary nail fixation for humeral shaft fracture of types B and C. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2013;27(12):1457–61.PubMed
18.
Guzman-Guevara J, Lopez-Cazares G, Barragan-Hervella RG, Villegas-Rosas JS, Alvarado-Ortega I, Montiel-Jarquin AJ. Evaluation of patients with humeral midshaft fractures treated with DCP plate vs. intramedullary nail UHN. Rev Med Inst Mex Seguro Soc. 2016;54(Suppl 3):S270–4.PubMed
19.
Bisaccia M, Meccariello L, Rinonapoli G, Rollo G, Pellegrino M, Schiavone A, et al. Comparison of plate, nail and external fixation in the management of diaphyseal fractures of the humerus. Med Arch. 2017;71(2):97–102.PubMedPubMedCentralCrossRef
20.
Changulani M, Jain UK, Keswani T. Comparison of the use of the humerus intramedullary nail and dynamic compression plate for the management of diaphyseal fractures of the humerus. A randomised controlled study. Int Orthop. 2007;31(3):391–5.PubMedCrossRef
21.
Chao TC, Chou WY, Chung JC, Hsu CJ. Humeral shaft fractures treated by dynamic compression plates, Ender nails and interlocking nails. Int Orthop. 2005;29(2):88–91.PubMedPubMedCentralCrossRef
22.
Chapman JR, Henley MB, Agel J, Benca PJ. Randomized prospective study of humeral shaft fracture fixation: intramedullary nails versus plates. J Orthop Trauma. 2000;14(3):162–6.PubMedCrossRef
23.
Chen F, Wang Z, Bhattacharyya T. Outcomes of nails versus plates for humeral shaft fractures: a Medicare cohort study. J Orthop Trauma. 2013;27(2):68–72.PubMedPubMedCentral
24.
Chiu FY, Chen CM, Lin CF, Lo WH, Huang YL, Chen TH. Closed humeral shaft fractures: a prospective evaluation of surgical treatment. J Trauma. 1997;43(6):947–51.PubMedCrossRef
25.
Denies E, Nijs S, Sermon A, Broos P. Operative treatment of humeral shaft fractures. Comparison of plating and intramedullary nailing. Acta Orthop Belg. 2010;76(6):735–42.PubMed
26.
Fan Y, Li YW, Zhang HB, Liu JF, Han XM, Chang X, et al. Management of humeral shaft fractures with intramedullary interlocking nail versus locking compression plate. Orthopedics. 2015;38(9):e825–9.PubMedCrossRef
27.
Flinkkila T, Hyvonen P, Siira P, Hamalainen M. Recovery of shoulder joint function after humeral shaft fracture: a comparative study between antegrade intramedullary nailing and plate fixation. Arch Orthop Trauma Surg. 2004;124(8):537–41.PubMedCrossRef
28.
Goncalves FF, Dau L, Grassi CA, Palauro FR, Martins Neto AA, Pereira PCG. Evaluation of the surgical treatment of humeral shaft fractures and comparison between surgical fixation methods. Rev Bras Ortop. 2018;53(2):136–41.PubMedPubMedCentralCrossRef
29.
Gottschalk MB, Carpenter W, Hiza E, Reisman W, Roberson J. Humeral shaft fracture fixation: incidence rates and complications as reported by American Board of Orthopaedic Surgery Part II Candidates. J Bone Joint Surg Am. 2016;98(17):e71.PubMedCrossRef
30.
Hashmi PM, Mohib Y, Abbas K. Functional and radiological outcome of Intramedullary nailing vs. plate fixation for humeral shaft fractures. Does treatment method bring any difference? J Pak Med Assoc. 2014;64(12 Suppl 2):S135–8.PubMed
31.
Khan AS, Afzal W, Anwar A. Comparison of shoulder function, radial nerve palsy and infection after nailing versus plating in humeral shaft fractures. J Coll Physicians Surg Pak. 2010;20(4):253–7.PubMed
32.
Kulkarni SG, Varshneya A, Jain M, Kulkarni VS, Kulkarni GS, Kulkarni MG, et al. Antegrade interlocking nailing versus dynamic compression plating for humeral shaft fractures. J Orthop Surg (Hong Kong). 2012;20(3):288–91.CrossRef
33.
Kulkarni VS, Kulkarni MS, Kulkarni GS, Goyal V, Kulkarni MG. Comparison between antegrade intramedullary nailing (IMN), open reduction plate osteosynthesis (ORPO) and minimally invasive plate osteosynthesis (MIPO) in treatment of humerus diaphyseal fractures. Injury. 2017;48(Suppl 2):S8–13.PubMedCrossRef
34.
Kumar R, Singh P, Chaudhary LJ, Singh S. Humeral shaft fracture management, a prospective study; nailing or plating. J Clin Orthop Trauma. 2012;3(1):37–42.PubMedPubMedCentralCrossRef
35.
Li Y, Wang C, Wang M, Huang L, Huang Q. Postoperative malrotation of humeral shaft fracture after plating compared with intramedullary nailing. J Shoulder Elbow Surg. 2011;20(6):947–54.PubMedCrossRef
36.
McCormack RG, Brien D, Buckley RE, McKee MD, Powell J, Schemitsch EH. 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):336–9.PubMedCrossRef
37.
Mulier T, Seligson D, Sioen W, van den Bergh J, Reynaert P. Operative treatment of humeral shaft fractures. Acta Orthop Belg. 1997;63(3):170–7.PubMed
38.
Putti AB, Uppin RB, Putti BB. Locked intramedullary nailing versus dynamic compression plating for humeral shaft fractures. J Orthop Surg (Hong Kong). 2009;17(2):139–41.CrossRef
39.
Radulescu R, Badila A, Nutiu O, Japie I, Terinte S, Radulescu D, et al. Osteosynthesis in fractures of the distal third of humeral diaphysis. Maedica (Buchar). 2014;9(1):44–8.
40.
Raghavendra S, Bhalodiya HP. Internal fixation of fractures of the shaft of the humerus by dynamic compression plate or intramedullary nail: a prospective study. Indian J Orthop. 2007;41(3):214–8.PubMedPubMedCentralCrossRef
41.
Rodriguez-Merchan EC. Compression plating versus hackethal nailing in closed humeral shaft fractures failing nonoperative reduction. J Orthop Trauma. 1995;9(3):194–7.PubMedCrossRef
42.
Singisetti K, Ambedkar M. Nailing versus plating in humerus shaft fractures: a prospective comparative study. Int Orthop. 2010;34(4):571–6.PubMedCrossRef
43.
Wali MG, Baba AN, Latoo IA, Bhat NA, Baba OK, Sharma S. Internal fixation of shaft humerus fractures by dynamic compression plate or interlocking intramedullary nail: a prospective, randomised study. Strategies Trauma Limb Reconstr. 2014;9(3):133–40.PubMedPubMedCentralCrossRef
44.
Wang Y, Kayastha Y, Cao Y, Guo Z, Yuan Y, Bi Y. Outcome of humeral shaft fracture treated with intramedullary nail and plate fixation. J Coll Physicians Surg Pak. 2020;30(1):73–8.PubMedCrossRef
45.
Zhang R, Yin Y, Li S, Hou Z, Jin L, Zhang Y. Intramedullary nailing versus a locking compression plate for humeral shaft fracture (AO/OTA 12-A and B): a retrospective study. Orthop Traumatol Surg Res. 2020;106(7):1391–7.PubMedCrossRef
46.
Akalin Y, Sahin IG, Cevik N, Guler BO, Avci O, Ozturk A. Locking compression plate fixation versus intramedullary nailing of humeral shaft fractures: which one is better? A single-centre prospective randomized study. Int Orthop. 2020;44(10):2113–21.PubMedCrossRef
47.
Wen H, Zhu S, Li C, Chen Z, Yang H, Xu Y. Antegrade intramedullary nail versus plate fixation in the treatment of humeral shaft fractures: an update meta-analysis. Medicine (Baltimore). 2019;98(46): e17952.CrossRef
48.
49.
Cheng HR, Lin J. Prospective randomized comparative study of antegrade and retrograde locked nailing for middle humeral shaft fracture. J Trauma. 2008;65(1):94–102.PubMed
Metadata
Title
Open plate fixation versus nailing for humeral shaft fractures: a meta-analysis and systematic review of randomised clinical trials and observational studies
Authors
Frank Joseph Paulus Beeres
Nicole van Veelen
Roderick Marijn Houwert
Björn Christian Link
Marilyn Heng
Matthias Knobe
Rolf Hendrik Herman Groenwold
Reto Babst
Bryan Joost Marinus van de Wall
Publication date
05-07-2021
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 4/2022
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-021-01728-7

Other articles of this Issue 4/2022

European Journal of Trauma and Emergency Surgery 4/2022 Go to the issue

Review Article

Synthesis of the evidence on the impact of pre-operative direct oral anticoagulants on patient health outcomes after hip fracture surgery: rapid systematic review

Original Article

Prognostic value of orthogeriatric assessment parameters on mortality: a 2-year follow-up

Original Article

Effect of surgical stabilization of rib fractures in polytrauma: an analysis of the TraumaRegister DGU®

Original Article

Predictors for wound healing complications and prolonged hospital stay in patients with isolated calcaneal fractures

Original Article

Efficacy of two integrated geriatric care pathways for the treatment of hip fractures: a cross-cultural comparison

Letter to the Editor

Letter to the Editor on: “Open plate fixation versus nailing for humeral shaft fractures: a meta-analysis and systematic review of randomised clinical trials and observational studies”