Chinese Journal of Tissue Engineering Research ›› 2021, Vol. 25 ›› Issue (36): 5878-5887.doi: 10.12307/2021.358

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Conservative treatment, open reduction, percutaneous minimally invasive plate internal fixation and intramedullary nail fixation in the treatment of humeral shaft fractures: a network meta-analysis

Xiong Chen1, 2, He Guiping3, Zhang Kun2, He Xiao2, Yang Jiarui2, He Changjun2, Wang Xiaolong2, Wang Chen2, Shi Zhengwei2, Zhu Yangjun2, Heng Lisong2   

  1. 1Yan’an University, Yan’an 716000, Shaanxi Province, China; 2Department of Orthopedic and Trauma, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, Shaanxi Province, China; 3Pingliang Rehabilitation Center Hospital, Pingliang 744000, Gansu Province, China
  • Received:2021-03-23 Revised:2021-03-25 Accepted:2021-04-17 Online:2021-12-28 Published:2021-09-18
  • Contact: Heng Lisong, Associate chief physician, Department of Orthopedic and Trauma, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, Shaanxi Province, China
  • About author:Xiong Chen, Master candidate, Physician, Yan’an University, Yan’an 716000, Shaanxi Province, China; Department of Orthopedic and Trauma, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, Shaanxi Province, China
  • Supported by:
    the Key Research & Development Project in Shaanxi Province, No. 2017SF-197 (to HLS); the Xi’an Science and Technology Project, No. 20YXYJ004(8) (to HLS)

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Abstract: OBJECTIVE: The main methods for the treatment of humeral shaft fractures are conservative treatment, open reduction and internal fixation, percutaneous minimally invasive plate internal fixation and intramedullary nail fixation, but the best treatment is still unclear. The network meta-analysis was used to compare the efficacy of conservative treatment, open reduction and internal fixation, percutaneous minimally invasive plate internal fixation and intramedullary nail fixation in the treatment of humeral shaft fractures.
METHODS:  A randomized controlled study on the treatment of humeral shaft fractures was searched in CNKI, Wangfang, VIP, Chinese BioMedical Literature Database, PubMed, EMbase, The Cochrane library and Web of Science. The search period was from inception to January 2021. The “bias risk assessment” tool recommended by Cochrane Collaboration Network was used to evaluate the quality of the literature. The RevMan 5.4 software and Stata 15.0 software were used to draw the graph and analyze the data of the network Meta.  
RESULTS: (1) A total of 23 randomized controlled trials were included. A total of 1 220 patients with humeral shaft fractures were divided into experimental group and control group. The control group was treated conservatively, and the experimental group was treated with open reduction and internal fixation, percutaneous minimally invasive plate internal fixation and intramedullary nail fixation. (2) Literature quality evaluation was included: 5 articles were of high quality and the other 18 were of low quality. (3) In terms of DASH score, the order of network Meta was as follows: open reduction and internal fixation > conservative > percutaneous minimally invasive plate internal fixation > intramedullary nail fixation. In terms of CMS score, the order of network Meta was as follows: open reduction and internal fixation > percutaneous minimally invasive plate internal fixation > conservative > intramedullary nail fixation. In terms of bone nonunion, the order of network Meta was as follows: percutaneous minimally invasive plate internal fixation > open reduction internal fixation > intramedullary nail fixation > conservative treatment. In terms of fracture healing time, the order of network Meta was as follows: percutaneous minimally invasive plate internal fixation > intramedullary nail fixation > open reduction and internal fixation > conservative. The network Meta order of iatrogenic radial nerve injury was conservative > percutaneous minimally invasive plate fixation > intramedullary nail fixation > open reduction and internal fixation. The order of total complications of network Meta was conservative > percutaneous minimally invasive plate internal fixation > open reduction and internal fixation > intramedullary nail fixation. 
CONCLUSION: A comprehensive analysis of the results of the network meta-analysis of the four intervention measures showed that the upper limb function DASH score and shoulder CMS score of the affected limb after open reduction and internal fixation were the best, but the incidence of complications was relatively high. More high-quality randomized controlled trials are needed to ensure the reliability of the results.

Key words: bone, humerus, humeral shaft fracture, open reduction and internal fixation, percutaneous minimally invasive plate internal fixation, intramedullary nail fixation, conservative treatment, network meta-analysis

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