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Evidence summaries

Compression Plating Versus Intramedullary Nailing for Humeral Shaft Fractures

Both compression plating and locked intramedullary nailing for primary surgical fixation of humeral shaft fractures in adults may have similar fracture union rates, but nailing may be associated with an increased risk of shoulder impingement. Level of evidence: "C"

Comment: The quality of evidence is downgraded by limitations in study quality (lack of blinding) and byimprecise results (limited study size for each comparison).

Summary

A Cochrane review [Abstract] 1 comparing compression plates and locked intramedullary nail fixation for humeral shaft fractures in adults included 5 studies with a total of 260 subjects undergoing surgery for either acute fractures or after early failure of conservative treatment. There was no significant difference in fracture union between plating and nailing (RR 1.05; 95% CI 0.97 to 1.13; 5 trials). There was a statistically significant increase in shoulder impingement following nailing when compared with plating (RR 0.12; 95% CI 0.04 to 0.38; 5 trials). Intramedullary nails were removed significantly more frequently than plates (RR 0.17; 95% CI 0.04 to 0.76; 3 trials). There was no statistically significant difference between plating and nailing in operating time, blood loss during surgery, iatrogenic radial nerve injury, return to pre-injury occupation by six months or American Shoulder and Elbow Surgeons (ASES) scores.

Clinical comments

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    References

    • Kurup H, Hossain M, Andrew JG. Dynamic compression plating versus locked intramedullary nailing for humeral shaft fractures in adults. Cochrane Database Syst Rev 2011;(6):CD005959. [PubMed]

Primary/Secondary Keywords