Nailing, plate fixation for humeral shaft fractures had similar complication rates
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Published results showed intramedullary nailing and plate fixation yielded similar rates of complications and predictable means of fixation and healing in patients with humeral shaft fractures.
Researchers used the PearlDiver database to collect systemic complications, fracture complications and mean prescribed morphine milligram equivalents among 1,610 patients who underwent either intramedullary nailing (n=526) or plate fixation (n=1,087) for humeral shaft fractures from the beginning of 2010 to the second quarter of 2017. Researchers used statistical analysis to compare data between the two groups.
Results showed an overall complication rate of 30.8% and 34.2% in the intramedullary nailing group and plate fixation group, respectively. Researchers found patients who received plate fixation had a greater risk for radial nerve palsy and infection at 90 days, 6 months and 1 year, while patients who received intramedullary nailing had higher rates of hardware removal for all time periods. However, patients who underwent plate fixation had a lower risk of rotator cuff repair for all time periods, according to results.
“These findings reinforce previous studies indicating that similar outcomes can be achieved through both [intramedullary] nailing and plating of humeral shaft fractures, with each having slight advantages and disadvantages,” the authors wrote. “Surgeons should consider many factors when choosing a treatment, including their own level of skill with each technique.”
Perspective
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In reviewing the article by Travis R. Flick, MD, and colleagues, I must admit that the most surprising finding to me was the high rate of complications associated with both techniques. As someone old enough to have lived through the evolution of modern humeral nails, I have many not-so-fond memories of the complications associated with the earlier nail designs. Based on this, I currently have limited indications for humeral nailing and typically think of compression plating as the treatment of choice and the option with a lower complication profile. However, the literature does not necessarily justify this bias, nor does this retrospective database study, which shows that complication rates and outcomes at 1 year are essentially the same for the two cohorts. However, it is also important to compare the types of complications seen, and the higher rate of radial nerve palsy in the plate group, a more devastating complication than needing hardware removal or rotator cuff repair after a nail, cannot be overlooked. Regardless, the overall conclusion of this study supports the surgeon choosing that procedure with which he or she is more comfortable and facile without fear of consigning the patient to a lesser outcome.
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