title: Meta-analysis of the outcomes of intramedullary nailing and plate fixation of humeral shaft fractures.
abstract: OBJECTIVE
  The purpose of this study is to compare the outcomes of intramedullary nailing and plate fixation in the treatment of humeral shaft fractures using meta-analysis.
  
  
  METHODS
  PubMed, MEDLINE, EMBASE, the Cochrane Controlled Clinical Trials Register (CCTR) databases were searched for studies that investigated the efficacy of intramedullary nailing and plate fixation in the management of humeral shaft fractures. Delayed healing rate, nonunion, postoperative infection and radial nerve paralysis were key outcomes of interest. Data were searched within the time period of July 1990 through September 2012. The statistical software RevMan 5.0 was used to analyze the statistical significance of the results.
  
  
  RESULTS
  Total 459 cases of patients in 10 literature, including 231 cases of plate group and 228 cases of the intramedullary nailing groups were collected. The results of meta-analysis showed that delayed healing rate of humeral shaft fractures was lower in plate fixation compared with intramedullary nailing (RR = 2.64, 95% CI (1.08, 6.49), P < 0.05). No statistically significant difference in nonunion, postoperative infections, radial nerve paralysis and other complications was identified between nailing and plate fixation groups (P > 0.05).
  
  
  CONCLUSIONS
  In general, the effect size of intramedullary nailing may be comparable to that of plate fixation in the terms of nonunion, postoperative infections, radial nerve paralysis. The only slightly difference was identified in the event of delayed healing rate.
authors.affiliation: Department 8, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing 400042, PR China. Electronic address: frankliugd@163.com.
authors.forename: Guo-dong
authors.initials: GD
authors.lastname: Liu
authors.forename: Qing-gang
authors.initials: QG
authors.lastname: Zhang
authors.forename: Shan
authors.initials: S
authors.lastname: Ou
authors.forename: Le-shun
authors.initials: LS
authors.lastname: Zhou
authors.forename: Jun
authors.initials: J
authors.lastname: Fei
authors.forename: Hong-wei
authors.initials: HW
authors.lastname: Chen
authors.forename: Guo-xin
authors.initials: GX
authors.lastname: Nan
authors.forename: Jian-wen
authors.initials: JW
authors.lastname: Gu
mesh_terms: D001858:Bone Nails; D001860:Bone Plates; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D006811:Humerus / Q000601:surgery; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
keywords: Humeral shaft fracture; Intramedullary nailing; Meta-analysis; Steel plate