Efficacy and Safety Evaluation of Intramedullary Nail and Locking Compression Plate in the Treatment of Humeral Shaft Fractures: A Systematic Review and Meta-analysis

Objective. The surgical treatment scheme of humeral shaft fracture is still controversial with no consensus reached. This meta-analysis was aimed at comparing the efficacy and safety of intramedullary nail (IMN) and locking compression plate (LCP) in the treatment of humeral shaft fractures. Methods. PubMed, Medline, Embase, Ovid, Cochrane Library, ISI Web of Science, Clinical Trials, and Chinese databases, including China National Knowledge Infrastructure Project, Wanfang database, and China biomedical abstracts database, were used to search the literature. Review Manager software was employed for statistical analysis and establishing forest and funnel maps. Categorical variables were measured by relative risk (RR), and standardized mean difference (SMD) was used to measure continuous variables. 95% confidence intervals were used for each variable. The modified Jadad scale, Newcastle-Ottawa scale, and Cochrane’s bias risk tools were used to evaluate the bias and risk of eligible studies. Results. A total of 14 studies were included in the analysis with a total of 903 patients with humeral shaft fracture. Significant differences with regard to operation time ( <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mtext>Std</a:mtext> <a:mo>=</a:mo> <a:mo>−</a:mo> <a:mn>1.18</a:mn> </a:math> , 95% CI: -2.14, -0.22, <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"> <c:mi>Z</c:mi> <c:mo>=</c:mo> <c:mn>2.41</c:mn> </c:math> , <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"> <e:mi>P</e:mi> <e:mo>=</e:mo> <e:mn>0.02</e:mn> </e:math> ), blood loss ( <g:math xmlns:g="http://www.w3.org/1998/Math/MathML" id="M4"> <g:mtext>Std</g:mtext> <g:mo>=</g:mo> <g:mo>−</g:mo> <g:mn>2.97</g:mn> </g:math> , 95% CI: -4.32, -1.63, <i:math xmlns:i="http://www.w3.org/1998/Math/MathML" id="M5"> <i:mi>Z</i:mi> <i:mo>=</i:mo> <i:mn>4.34</i:mn> </i:math> , <k:math xmlns:k="http://www.w3.org/1998/Math/MathML" id="M6"> <k:mi>P</k:mi> <k:mo>&lt;</k:mo> <k:mn>0.001</k:mn> </k:math> ), and postoperative infection rate ( <m:math xmlns:m="http://www.w3.org/1998/Math/MathML" id="M7"> <m:mtext>RR</m:mtext> <m:mo>=</m:mo> <m:mn>0.32</m:mn> </m:math> , 95% CI: -0.15, 0.68, <o:math xmlns:o="http://www.w3.org/1998/Math/MathML" id="M8"> <o:mi>Z</o:mi> <o:mo>=</o:mo> <o:mn>2.98</o:mn> </o:math> , <q:math xmlns:q="http://www.w3.org/1998/Math/MathML" id="M9"> <q:mi>P</q:mi> <q:mo>=</q:mo> <q:mn>0.003</q:mn> </q:math> ) were noted between the IMN group and LCP group. In addition, the American Shoulder and Elbow Surgeon (ASES) score ( <s:math xmlns:s="http://www.w3.org/1998/Math/MathML" id="M10"> <s:mtext>Std</s:mtext> <s:mo>=</s:mo> <s:mo>−</s:mo> <s:mn>0.22</s:mn> </s:math> , 95% CI: -0.44, 0.01, <u:math xmlns:u="http://www.w3.org/1998/Math/MathML" id="M11"> <u:mi>Z</u:mi> <u:mo>=</u:mo> <u:mn>2.08</u:mn> </u:math> , <w:math xmlns:w="http://www.w3.org/1998/Math/MathML" id="M12"> <w:mi>P</w:mi> <w:mo>=</w:mo> <w:mn>0.04</w:mn> </w:math> ) and the rate of shoulder and elbow function limitation ( <y:math xmlns:y="http://www.w3.org/1998/Math/MathML" id="M13"> <y:mtext>RR</y:mtext> <y:mo>=</y:mo> <y:mn>1.88</y:mn> </y:math> , 95% CI: 1.06, 3.33, <ab:math xmlns:ab="http://www.w3.org/1998/Math/MathML" id="M14"> <ab:mi>Z</ab:mi> <ab:mo>=</ab:mo> <ab:mn>2.17</ab:mn> </ab:math> , <cb:math xmlns:cb="http://www.w3.org/1998/Math/MathML" id="M15"> <cb:mi>P</cb:mi> <cb:mo>=</cb:mo> <cb:mn>0.03</cb:mn> </cb:math> ) between the 2 groups were also statistically significant. There were no significant differences in the rate of radial nerve injury, nonunion, delayed healing, and secondary operation between the two groups. Conclusion. IMN is superior than the LCP in terms of the operation time, intraoperative bleeding, and postoperative infection, suggesting its superiority in the humeral shaft fracture fixation. However, IMN is inferior to LCP in ASES score and shoulder elbow function limitation rate, indicating poor early postoperative functional recovery. More studies are required to evaluate and analyze the clinical efficacy between IMN and LCP regarding long-term function after artificial graft removal.

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