Compression plating versus intramedullary nailing of humeral shaft fractures--a meta-analysis.
BACKGROUND
The choice of plates or intramedullary nails for operatively treated humeral shaft fractures remains controversial, since randomized controlled trials have lacked sufficient power. A meta-analysis of existing trials would improve inferences regarding the treatment effect.


METHODS
We reviewed randomized trials in Medline, Cochrane and SciSearch, along with other sources of published randomized trials from 1969-2000. Of 215 citations identified, only 3 studies were included.


RESULTS
The 3 studies (involving 155 patients) were pooled, since they were homogeneous (p > 0.1). Plate fixation gave a lower relative risk of reoperation than intramedullary nailing (RR = 0.26, 95% CI 0.007-0.9, p = 0.03). This translated to a risk reduction of 74% for reoperation when plate fixation was employed. Thus, 1 reoperation could be prevented for every 10 patients treated with plates. Plate fixation also reduced the risk of shoulder problems in comparison to intramedullary nails (RR = 0.10, 95% CI 0.03-0.4, p = 0.002).


CONCLUSIONS
Plate fixation of humeral shaft fractures may reduce the risk of reoperation and shoulder impingement. The cumulative evidence remains inconclusive, and a larger trial is needed in order to confirm these findings.
Bhandari
Mohit
M
Department of Clinical Epidemiology, McMaster Univerisity, Ontario, Canada. bhandam@mcmaster.ca
Devereaux
P J
PJ
McKee
Michael D
MD
Schemitsch
Emil H
EH
D001858:Bone Nails; D001860:Bone Plates; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D017102:Fracture Healing; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D012086:Reoperation; D016896:Treatment Outcome