Efficacy and Safety Evaluation of Intramedullary Nail and Locking Compression Plate in the Treatment of Humeral Shaft Fractures: A Systematic Review and Meta-analysis
Bibliographic record
Abstract
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><</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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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.006 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".