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Meta-analysis finds no difference between plates, nails for humeral shaft fractures
Heineman DJ. Acta Orthop. 2010;81(2):218-225. April 2010.
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A recent meta-analysis found statistically insignificant differences between plate fixation and intramedullary nails as treatments for humeral shaft fractures.
“Small sample sizes, study heterogeneity and methodological limitations argue strongly for a definitive, large trial,” the authors wrote in their abstract. “We recommend that this trial should be a randomized controlled trial with appropriate allocation of patients and blinding of patients and care providers and outcome assessors, and that it should include patient-important outcomes.”
David J. Heineman, MD, and colleagues conducted a meta-analysis of trials comparing humeral shaft fracture treatment. Their literature search from 1967 to November 2007 yielded four randomized trials that compared intramedullary nails and plates in patients with humeral shaft fractures. These trials also reported surgery-related complications. The investigators statistically pooled patient data using standard meta-analytic approaches, according to the abstract.
Their primary outcome was the total complication rate across all four trials. They also included nonunion, infection, nerve palsy and reoperation rate as secondary outcomes.
After pooling the data, the investigators found no statistically significant difference between implants with regard to total complications, nonunions, infection, nerve palsy or reoperation rates. The investigators noted that the studies they included were small and had methodological limitations.