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Plate fixation or intramedullary fixation of humeral shaft fractures--an update.

Heineman DJ, Bhandari M, Poolman RW - Acta Orthop (2012)

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Sir—In April 2010 we published a meta-analysis with the title “Plate fixation or intramedullary fixation of humeral shaft fractures” in Acta Orthopaedica... Since this last update new trials have been published on this subject, therefore justifying a new update of this meta-analysis... Regarding our primary outcome, total complication rate, one new trial has been published by describing the results of a prospective, comparative study of management of acute humeral shaft fractures by antegrade interlocking nail fixation and dynamic compression plating... Unfortunately this study does not mention total complication rate, the primary outcome of our meta-analysis... It is remarkable that the confidence interval is smaller than it was in our last update (CI = 0.30–0.91), suggesting less heterogeneity... Regarding our secondary outcomes, non-union, infection and nerve palsy, this new analysis shows no new significant differences (Table)... After updating our analysis we can conclude that the current literature continues to favor plates over intramedullary nails in humeral shaft fractures in the reduction of complication rates... However, the precision of our estimate is markedly improved (CI = 0.41–0.97 instead of CI = 0.30–0.91)... We have to remark though that the significance is a bit less than it was in 2010 (p = 0.03 instead of p = 0.01)... Regarding our secondary outcomes there still is no significant difference between nails and plates... The weaknesses stated in our last update still remain viable: small studies with heterogeneity remain the basis of this meta-analysis... The need for a large scale RCT reporting on patient important endpoints such as complication rate and validated patient reported outcomes still remains.

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Cumulative meta-analysis of primary outcome: total complication rate.
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Figure 1: Cumulative meta-analysis of primary outcome: total complication rate.

Mentions: By including these three trials we could add 155 patients in total. Regarding our primary outcome total complication rate we can state that this new update shows a less significant result favoring plates compared to nails (RR 0.63, CI = 0.41–0.97, p = 0.03) (Figure). It is remarkable that the confidence interval is smaller than it was in our last update (CI = 0.30–0.91), suggesting less heterogeneity. Regarding our secondary outcomes, non-union, infection and nerve palsy, this new analysis shows no new significant differences (Table).


Plate fixation or intramedullary fixation of humeral shaft fractures--an update.

Heineman DJ, Bhandari M, Poolman RW - Acta Orthop (2012)

Cumulative meta-analysis of primary outcome: total complication rate.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3369163&req=5

Figure 1: Cumulative meta-analysis of primary outcome: total complication rate.
Mentions: By including these three trials we could add 155 patients in total. Regarding our primary outcome total complication rate we can state that this new update shows a less significant result favoring plates compared to nails (RR 0.63, CI = 0.41–0.97, p = 0.03) (Figure). It is remarkable that the confidence interval is smaller than it was in our last update (CI = 0.30–0.91), suggesting less heterogeneity. Regarding our secondary outcomes, non-union, infection and nerve palsy, this new analysis shows no new significant differences (Table).

View Article: PubMed Central - PubMed

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Sir—In April 2010 we published a meta-analysis with the title “Plate fixation or intramedullary fixation of humeral shaft fractures” in Acta Orthopaedica... Since this last update new trials have been published on this subject, therefore justifying a new update of this meta-analysis... Regarding our primary outcome, total complication rate, one new trial has been published by describing the results of a prospective, comparative study of management of acute humeral shaft fractures by antegrade interlocking nail fixation and dynamic compression plating... Unfortunately this study does not mention total complication rate, the primary outcome of our meta-analysis... It is remarkable that the confidence interval is smaller than it was in our last update (CI = 0.30–0.91), suggesting less heterogeneity... Regarding our secondary outcomes, non-union, infection and nerve palsy, this new analysis shows no new significant differences (Table)... After updating our analysis we can conclude that the current literature continues to favor plates over intramedullary nails in humeral shaft fractures in the reduction of complication rates... However, the precision of our estimate is markedly improved (CI = 0.41–0.97 instead of CI = 0.30–0.91)... We have to remark though that the significance is a bit less than it was in 2010 (p = 0.03 instead of p = 0.01)... Regarding our secondary outcomes there still is no significant difference between nails and plates... The weaknesses stated in our last update still remain viable: small studies with heterogeneity remain the basis of this meta-analysis... The need for a large scale RCT reporting on patient important endpoints such as complication rate and validated patient reported outcomes still remains.

Show MeSH