Compression plating versus intramedullary nailing of humeral shaft fractures--a meta-analysis

BACKGROUND: The choice of plates or intramedullary nails for operatively treated humeral shaft fractures remains controversial, since randomized controlled trials have lacked sufficient power. A meta-analysis of existing trials would improve inferences regarding the treatment effect. METHODS: We reviewed randomized trials in Medline, Cochrane and SciSearch, along with other sources of published randomized trials from 1969-2000. Of 215 citations identified, only 3 studies were included. RESULTS: The 3 studies (involving 155 patients) were pooled, since they were homogeneous (p > 0.1). Plate fixation gave a lower relative risk of reoperation than intramedullary nailing (RR = 0.26, 95% CI 0.007-0.9, p = 0.03). This translated to a risk reduction of 74% for reoperation when plate fixation was employed. Thus, 1 reoperation could be prevented for every 10 patients treated with plates. Plate fixation also reduced the risk of shoulder problems in comparison to intramedullary nails (RR = 0.10, 95% CI 0.03-0.4, p = 0.002). INTERPRETATION: Plate fixation of humeral shaft fractures may reduce the risk of reoperation and shoulder impingement. The cumulative evidence remains inconclusive, and a larger trial is needed in order to confirm these findings.