title: A Bayesian network meta-analysis of three different surgical procedures for the treatment of humeral shaft fractures.
abstract: BACKGROUND
  The optimal surgical procedure for humeral shaft fractures remains a matter of debate. We aimed to establish the optimum procedure by performing a Bayesian network meta-analysis.
  
  
  METHODS
  PubMed, EMBASE, the Cochrane Library, and Medline were searched for both randomized controlled trials and prospective studies of surgical treatment for humeral shaft fractures. The quality of the included studies was assessed according to the Cochrane Collaboration's "Risk of bias".
  
  
  RESULTS
  Seventeen RCTs or prospective studies were included in the meta-analysis. The pooled results showed that the occurrence rate of radial nerve injury was lowest for minimally invasive plate osteosynthesis (MIPO; SUCRA probability, 95.1%), followed by open reduction and plate osteosynthesis (ORPO; SUCRA probability, 29.5%), and was highest for intramedullary nailing (IMN; SUCRA probability, 25.4%). The aggregated results of pairwise meta-analysis showed no significant difference in radial nerve injury rate when comparing ORPO versus IMN (OR, 1.92; 95% CI, 0.96 to 3.86), ORPO versus MIPO (OR, 3.38; 95% CI, 0.80 to 14.31), or IMN versus MIPO (OR, 3.19; 95% CI, 0.48 to 21.28). Regarding the nonunion, SUCRA probabilities were 90.5%, 40.2%, and 19.3% for MIPO, ORPO, and IMN, respectively. The aggregated results of a pairwise meta-analysis also showed no significant difference for ORPO versus IMN (OR, 0.83; 95% CI, 0.41 to 1.69), ORPO versus MIPO (OR, 2.42; 95% CI, 0.45 to 12.95), or IMN versus MIPO (OR, 2.49; 95% CI, 0.35 to 17.64).
  
  
  CONCLUSIONS
  The current evidence indicates that MIPO is the optimum choice in the treatment of humeral shaft fractures and that ORPO is superior to IMN.
authors.affiliation: Department of Orthopaedic Surgery, Yongchuan Hospital of Chongqing Medical University Department of Orthopaedic Surgery, The Children's Hospital of Chongqing Medical University Department of Endocrinology, The Second Affiliated Hospital of Chongqing Medical University Department of Endocrinology, Yongchuan Hospital of Chongqing Medical University Department of Orthopaedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Qiu
authors.forename: Zhihui
authors.initials: Z
authors.lastname: Wei
authors.forename: Yuting
authors.initials: Y
authors.lastname: Liu
authors.forename: Jing
authors.initials: J
authors.lastname: Dong
authors.forename: Xin
authors.initials: X
authors.lastname: Zhou
authors.forename: Liangjun
authors.initials: L
authors.lastname: Yin
authors.forename: Minhua
authors.initials: M
authors.lastname: Zhang
authors.forename: Minpeng
authors.initials: M
authors.lastname: Lu
mesh_terms: D001499:Bayes Theorem; D001860:Bone Plates; D005593:Fracture Fixation, Internal / Q000379:methods; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D000070799:Open Fracture Reduction / Q000379:methods