Meta-analysis of plating versus intramedullary nailing for forearm shaft fractures in adults

doi:10.3969/j.issn.2095-4344.2014.40.026

Abstract

Abstract:

BACKGROUND: The ways of surgical fixation of forearm shaft fractures contained plate fixation and intramedullary nail fixation. The advantage of plate fixation is anatomical reduction. The disadvantage is more peeled tissues, which greatly destroys blood supply and many surgical complications. Moreover, refracture easily appeared. The advantage of intramedullary nailing is minimal invasion, but disadvantage is poor ability to control the rotation. It remains controversial that plate fixation and intramedullary nail fixation for forearm shaft fractures which can obtain better repair effects.

OBJECTIVE: To systematically evaluate the efficacy of plate fixation and intramedullary nail fixation in the repair of forearm shaft fractures in adults.

METHODS: We retrieved PubMed, MEDLINE, CINAHL, EBM, Chinese BioMedical Literature Database, Wanfang Database and Chinese Academic Journal Network, and retrieved Chinese Journal of Surgery by hand. Prospective or retrospective comparative studies concerning plate fixation versus intramedullary nailing for forearm shaft fractures were collected. Jadad was utilized to assess methodological quality of the included studies. Effective data were extracted using Stata 12.0 software for meta-analysis.

RESULTS AND CONCLUSION: Totally four clinical trials were included, including one prospective clinical trial and three retrospective observational studies. No significant differences were found in functional outcomes, complications, bone union time, operative time, forearm rotation arc, refracture and nonunion between plate fixation and intramedullary nail fixation groups. Results indicated that plate fixation and intramedullary nail fixation in the repair of forearm shaft fractures in adults obtained identical effects. However, the reliability of study results should be verified by randomized controlled trial of multi-center, large-sample and long-period follow-up.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: ulna fractures, radius fractures, internal fixators, evidence-based medicine, meta-analysis

CLC Number:

R318

Li Lian-hua, Wang Hao, Wu Da-long, Zhang Yan, Cai Yan-hong, Liu Zhi, Sun Tian-sheng. Meta-analysis of plating versus intramedullary nailing for forearm shaft fractures in adults[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(40): 6548-6552.

Figures/Tables 2

2.1 检索结果文献检索纳入的过程详见图1。共查到相关文献116篇。通过阅读文题、摘要和全文，排除与本系统评价目的不符、综述、临床单样本无对照的研究、无对照的随访或重复发表文献后，剩下4篇文献。其中研究地点1篇在国内，3篇在国外，语种上1篇为中文，2篇为英文，1篇为捷克语。各纳入研究的基本情况见表1。 2.2 主要结局指标功能评价：有3个研究报告了功能评价情况[5，7-8]，共128例患者，其中Ozkaya等[5]及Behnke等[8]的研究采用Grace-Eversmann标准报告优良率，而曲宪芳等[7]采用Anderson方法报告优良率，各研究间异质性不明显(P=0.78，I2=0%)，采用固定模型，如图2所示，总体的Meta分析结果显示，OR=0.81(0.32，2.08)，P=0.67，这说明钢板与髓内针修复前臂骨干骨折功能评价效果相当。采用 Egger’s方法检验纳入文献的发表偏倚，P=0.10，无显著性发表偏倚。并发症：有4个研究报道了总并发症的发生率[5-8]，共208例患者，各研究间无明显异质性(P=0.45，I2=0.0%)，采用固定模型进行分析，Meta分析结果显示，OR=0.99 (0.40，2.47)，P=0.99，2种修复方法并发症发生率相当。采用Egger’s方法检验纳入文献的发表偏倚，P=0.09，无显著性发表偏倚。 2.3 次要结局指标在次要结局指标中连续变量包括骨折愈合时间、手术时间及前臂旋转活动弧等，二分变量包括再骨折、骨不连发生情况。研究中没有提供算术均数与标准差，但提供了最大、最小值者，用cochrane手册中处理缺失值的方法进行换算。各个指标的纳入研究、病例数、异质性检验、Meta分析的结果详见表2，3。所有次要结局指标的Meta分析结果，两组之间相比较差异均无显著性意义，说明无论是在骨折愈合时间、手术时间、前臂旋转活动度，还是在再骨折、骨不连发生率上两者的效果均相当。"

References

[1] 张长青,曾炳芳,唐明杰,等.应用前臂交锁髓内钉治疗前臂骨折[J]. 中华手外科杂志, 2004,20(1):18-20.
[2] Chung KC, Spilson SV. The frequency and epidemiology of hand and forearm fractures in the united states: abstract. J Hand Surg[Am]. 2001;26:908-915.
[3] Dymond IW. The treatment of isolated fractures of the distal ulna. J Bone Joint Surg Br. 1984; 66:408-410.
[4] Jones DB Jr, Kakar S. Adult diaphyseal forearm fractures: intramedullary nail versus plate fixation. J Hand Surg Am. 2011;36(7):1216-1219.
[5] Ozkaya U, Kilic A, Ozdogan U, et al.Comparison between locked intramedullary nailing and plate osteosynthesis in the management of adult forearm fractures. Acta Orthop Traumatol Turc. 2009;43(1):14-20.
[6] Visna P, Vlcek M, Valcha M, et al. [Management of diaphyseal forearm fractures using LCP angle- stable fixation devices and intramedullary nailing]. Rozhl Chir. 2009;88(12):708-715.
[7] 曲宪芳,赵宇,刘书茂,等. AO接骨板与Sanatmetal髓内钉固定治疗尺桡骨单节段双骨折的比较[J].中国骨与关节外科, 2011, 4(6):460-463.
[8] Behnke NM, Redjal HR, Nguyen VT, et al. Internal fixation of diaphyseal fractures of the forearm: a retrospective comparison of hybrid fixation versus dual plating. J Orthop Trauma. 2012;26(11):611-616.
[9] 马晓春.不同治疗方法对尺桡骨干双骨折前臂功能的影响研究[J].临床医学工程, 2012,19(5):738-739.
[10] Schemitsch EH, Jones D, Henley MB, et al. A comparison of malreduction after plate and intramedullary nail fixation of forearm fractures. J Orthop Trauma. 1995;9(1):8-16.
[11] Wells GA, Shea B, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses [EB/OL]. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
[12] Chapman MW, Gordon JE, Zissimos AG. Compression-plate fixation of acute fractures of the diaphyses of the radius and ulna. J Bone Joint Surg Am. 1989;71(2):159-169.
[13] Anderson LD, Sisk D, Tooms RE, et al. Compression-plate fixation in acute diaphyseal fractures of the radius and ulna. J Bone Joint Surg Am. 1975;57(3):287-297.
[14] Schemitsch EH, Richards RR. The effect of malunion on functional outcome after plate fixation of fractures of both bones of the forearm in adults. J Bone Joint Surg Am. 1992; 74(7):1068-1078.
[15] Mih AD, Cooney WP, Idler RS, et al. Long-term follow-up of forearm bone diaphyseal plating. Clin Orthop Relat Res. 1994; (299):256-258.
[16] Trlica J, Pocepcov I, Koci J, et al. [True/Flex intramedullary nailing for forearm shaft fractures. Long-term results]. Acta Chir Orthop Traumatol Cech. 2012;79(4):347-354.
[17] Lee YH, Lee SK, Chung MS, et al. Interlocking contoured intramedullary nail fixation for selected diaphyseal fractures of the forearm in adults. J Bone Joint Surg Am. 2008;90(9): 1891-1898.
[18] Rehman S, Sokunbi G. Intramedullary fixation of forearm fractures. Hand Clin. 2010;26(3):391-401.