Surgical interventions to treat humerus shaft fractures: A network meta-analysis of randomized controlled trials.
BACKGROUND
There are three main surgical techniques to treat humeral shaft fractures: open reduction and plate fixation (ORPF), intramedullary nail (IMN) fixation, and minimally invasive percutaneous osteosynthesis (MIPO). We performed a network meta-analysis to compare three surgical procedures, including ORPF, IMN fixation, and MIPO, to provide the optimum treatment for humerus shaft fractures.


METHODS
MEDLINE, EMBASE, Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, and Cochrane library were researched for reports published up to May 2016. We only included randomized controlled trials (RCTs) comparing two or more of the three surgical procedures, including the ORPF, IMN, and MIPO techniques, for humeral shaft fractures in adults. The methodological quality was evaluated based on the Cochrane risk of bias tool. We used WinBUGS1.4 to conduct this Bayesian network meta-analysis. We used the odd ratios (ORs) with 95% confidence intervals (CIs) to calculate the dichotomous outcomes and analyzed the percentages of the surface under the cumulative ranking curve.


RESULTS
Seventeen eligible publications reporting 16 RCTs were included in this study. Eight hundred and thirty-two participants were randomized to receive one of three surgical procedures. The results showed that shoulder impingement occurred more commonly in the IMN group than with either ORPF (OR, 0.13; 95% CI, 0.03-0.37) or MIPO fixation (OR, 0.08; 95% CI, 0.00-0.69). Iatrogenic radial nerve injury occurred more commonly in the ORPF group than in the MIPO group (OR, 11.09; 95% CI, 1.80-124.20). There were no significant differences among the three procedures in nonunion, delayed union, and infection.


CONCLUSIONS
Compared with IMN and ORPF, MIPO technique is the preferred treatment method for humeral shaft fractures.
Departments of Orthopaedic Surgery, Clinical College of Orthopaedic Surgery, Tianjin Medical University, Tianjin, China.|Department of Orthopaedic Surgery, Tianjin Hospital, Tianjin, China.
Jia-Guo
http://orcid.org/0000-0001-5799-3988
JG
Zhao
Department of Orthopaedic Surgery, Tianjin Hospital, Tianjin, China.
Jia
J
Wang
Department of Orthopaedic Surgery, Yixing Traditional Chinese Medicine Hospital, Yixing, Jiangsu Province, China.
Xiao-Hui
XH
Meng
Department of Orthopaedic Surgery, Tianjin Hospital, Tianjin, China.
Xian-Tie
XT
Zeng
Department of Orthopaedic Surgery, Tianjin Hospital, Tianjin, China.
Shi-Lian
SL
Kan
D000328:Adult; D001860:Bone Plates; D005260:Female; D005593:Fracture Fixation, Internal; D005594:Fracture Fixation, Intramedullary; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D016032:Randomized Controlled Trials as Topic