26 / 2017-03-28 15:12:58

A pooled meta-analysis of intramedullary nail versus locking plate for treatment of proximal humeral fracture: based on 20 studies

locking plate,intramedullary nail,proximal humeral fracture,meta-analysis

Purpose
The optimal way of using intramedullary nail or locking plate as surgical treatment for proximal humeral fractures remains uncertain. This study aimed to evaluate the clinical outcomes of these two procedures according to evidence-based method and give better therapeutic suggestions for both doctors and patients.
Methods
Literature search from Jan.1, 1996 to Dec.31, 2016 was performed using the electronic databases (including Pubmed, Embase, Cochrane Library, CNKI, VIP and Wanfang database).The relevant controlled clinical trials that investigated Intramedullary nail versus locking plate in treating proximal humeral fractures were identified. Incision length, blood loss, operation time, fracture healing time, postoperative complications and Constant Score in patients were pooled respectively. The methodological quality and recommendations of individual study were evaluated using the GRADE system and Revman 5.3 software of Cochrane Collaboration was used to analyze the trials.
Results
Twenty of the published literature involving 1384 patients met the eligibility requirements. Meta-analysis revealed that intramedullary nail is superior to locking plate in Incision length (SMD=-3.51, 95%CI: -5.30 to -1.72), blood loss (SMD=-2.85, 95%CI: -3.73 to -1.97), operation time (SMD=-1.59, 95%CI: -1.94 to -1.24), and fracture healing time (SMD=-0.63, 95%CI, -1.06 to -0.20). However, there were no differences in Constant Score (SMD=-0.05, 95%C: -0.18 to -0.07) and postoperative complications (RR=1.07, 95%CI: 0.84 to 1.36).
Conclusions
Compare with the locking plate, the Intramedullary nailing may be better choice for the treatment of proximal humeral fractures. Due to the limited quantity of the original studies currently, high-quality studies are still required.