Intramedullary Nailing Or Compression Plates For Humeral Shaft Fractures In Adults: A Systematic Review

Objective:To determine the effect of intramedulllary nailing versus compression plates in adults on the rates of secondary surgery,the rates of nonunion,the rates of infection,the rates of iatrogenic radial nerve injury,and the time of union,the influence of shoulder and elbow joint.Methods:we searched the specialized trials registered in Cochrane muscle bone group,Cochraneliabrary(CCTR),MEDLINE(1966-2006), EMBASE(1980-2006),PUBMEB(1966-2006),NRR(http://www.update-software.com/ National/),CCT(http://www.controlled-trials.com),and CBMdisc(1979-July2006),and we handsearched some Chinese orthoopaedics Journals.Data were extracted and evaluated by two reviewers independently of each other.Randomized controlled trials of intramedullary nailing versus compression plates for humeral shaft fractures in adults were included.The quality of trials was critical assessed.RevMan 4.2.8 software was used for data analysis.Result:Three RCTS of intramedullary nails versus compression plates for humeral shaft fractures in adults were included.Three studies including a total of 215 patients met the inclusion criteria for the review.The results of meta-analysis showed that intramedullary nails for humeral shaft fractures in adults increased the rates of secondary surgery[OR=2.68,95%CI(1.19,6.04),p=0.02],increased the pains in shoulder[OR=13.02,95%CI(2.23,75.95),p=0.004],and increased rates of decreased range of motion of shoulder[OR=18.60,95%CI(1.01,341.83),p=0.05].In aspects of complications,including the rates of nonunion,the rates of infection,the rates of iatrogenic radial nerve injury,intramedullary nails versus compression plates,there are no evident differences in statistics.The time of union was not used for Meta-analysis because included trials did not offer detailed data.Conclusion:compared with compression plates for humeral shaft fractures in adults,intramedullary nails increased the rates of secondary surgery,increased the pains in shoulder,increased rates of decreased range of motion of shoulder,there are no statistical difference in the rates of nonunion,the rates of infection, the rates of iatrogenic radial nerve injury,however,because the systematic review included few patients,further studies are needed to determine the effects of intramedulla- ry nails and compression plates on these outcomes.