Elastic stable intramedullary nailing versus plate fixation for the repair of humeral fractures in children: a meta-analysis

doi:10.3969/j.issn.2095-4344.2015.17.028

Abstract

Abstract:

BACKGROUND: There is no consensus on the choice of elastic stable intramedullary nailing or plate fixation for the treatment of humeral fractures in children. Current research is limited to small-sample studies, and it is difficult to carry out a large-sample multicenter analysis.

OBJECTIVE: To evaluate the efficacy and safety of elastic stable intramedullary nailing and plate fixation for the treatment of humeral fractures in children with meta-analysis.

METHODS: The PubMed database, EMbase database, CBM database, CNKI database, VIP database and Wangfang database were searched with computer to collect the controlled trials of elastic stable intramedullary nailing versus plate fixation for humerus fractures in children, and related journals were manually searched. The searching time ranged from the date of database establishment to August 2014. The trails were selected, the data were extracted and the quality was evaluated by two investigators independently.

RESULTS AND CONCLUSION: Two randomized controlled trials and three retrospective controlled trials were included in the meta-analysis. The Meta-analysis results showed that the postoperative functional recovery Constant score of the elastic stable intramedullary nailing group was higher than that of the plate fixation group (P < 0.01). The bone union time, operation time, incision length, intraoperative blood loss and the hospital stay of the

elastic stable intramedullary nailing group were less than those of the plate fixation group (P < 0.01). There were no significant differences in incidence rate of complications, nonunion, wound infection and malunion between two groups (P > 0.05). Based on the current evidence, elastic stable intramedullary nailing for the treatment of humeral fractures in children is superior to the plate fixation in the efficacy. There is no significant difference in incidence rate of complications between elastic stable intramedullary nailing and plate fixation. But all the studies were small-sample, and high-risk original study. Clinical trials with adequate samples, rational design and strict execution shall be carried out to provide more reliable evidence.

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: Humerus, Fractures, Bone, Bone Nails, Internal Fixators, Fracture Healing, Meta-Analysis

CLC Number:

R318

Lv Gang, Meng Qing-cai, Miao De-sheng, Ma Lei . Elastic stable intramedullary nailing versus plate fixation for the repair of humeral fractures in children: a meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(17): 2782-2788.

Figures/Tables 11

References

[1]Beaty JH. Fractures of the proximal humerus and shaft in children. Instr Course Lect. 1992;41:369-372.
[2]Jubel A, Andermahr J, Isenberg J, et al. Experience with elastic stable intramedullary nailing (ESIN) of shaft fractures in children. Orthopade. 2004;33(8):928-935.
[3]Steffner RJ, Lee MA. Emerging concepts in upper extremity trauma: humeral shaft fractures. Orthop Clin North Am. 2013; 44(1):21-33.
[4]Lascombes PT, Journeau HP. Use and abuse of flexible intramedullary nailing in children and adolescents. J Pediatr Orthop. 2006;26(6):827-834.
[5]Schaffer K, Bohm R, Dietz HG. [Elastic stable intramedullary nailing (ESIN) of supracondylar fractures of the humerus in children]. Unfallchirurg. 2007;110(10):852-858.
[6]徐璐杰,朱建.儿童长骨骨折弹性髓内针治疗后骨延迟愈合及不愈合[J].中华小儿外科杂志,2012,33(1):38-41.
[7]慕明章,唐伟,杨建平.克氏针髓内交叉固定治疗儿童肱骨干骨折 [J].中华小儿外科杂志,2006, 27(9):495-496.
[8]董展,楼跃,唐凯,等.弹性髓内钉微创治疗小儿肱骨干骨折33例 [J].中华创伤杂志,2014,30(4):333-335.
[9]王小林,邵景范,杨小进,等. 弹性髓内针固定治疗大龄儿童严重移位肱骨近端骨折[J].中国修复重建外科杂志,2014,28(3):345-348.
[10]肖健,邱晗,陈蕾.闭合复位弹性髓内针固定治疗儿童四肢长骨粉碎性骨折[J].长春中医药大学学报, 2013,29(4):680-681,687.
[11]孙祥水,楼跃,唐凯,等.弹性髓内针逆行髓内固定治疗大龄儿童肱骨近端骨折 [J].南京医科大学学报•自然科学版, 2013,33(4): 537-539.
[12]周曙光,陈建雯,俞辉国.弹性髓内针治疗儿童长骨骨折[J].实用骨科杂志,2012,18(4):306-308.
[13]杨宜,舒世琼,鲍同柱.弹性钛髓内钉固定治疗儿童肱骨髁上骨折肘内翻畸形矫治中的应用研究[J].中国医药导报, 2012, 9(26):58-59.
[14]王伟,程少文,彭磊,等.弹性髓内钉在儿童肱骨骨折中的应用[J]. 临床小儿外科杂志,2011,10(1):30-32.
[15]蔡豪祺,王志刚,蔡海清,等.钛制弹性髓内钉治疗儿童肱骨高位髁上骨折及交界性骨折[J].中华小儿外科杂志, 2011, 32(11):845-849.
[16]刘俊才,王月敏,纪春生,等.应用钛制弹性髓内针微创治疗儿童长骨骨折[J].黑龙江医学, 2010,10(9):694-695.
[17]胡孔才,曹进,诸葛天瑜,等.闭合复位弹性髓内钉内固定治疗儿童肱骨干骨折[J].中医正骨,2010, 22(9):58-59.
[18]Lefevre Y, Journeau P, Angelliaume A, et al. Proximal humerus fractures in children and adolescents. Orthop Traumatol Surg Res. 2014;100(1 Suppl):S149-156.
[19]Khan A, Athlani L, Rousset M, et al. Functional results of displaced proximal humerus fractures in children treated by elastic stable intramedullary nail. Eur J Orthop Surg Traumatol. 2014;24(2):165-172.
[20]Canavese F, Athlani L, Marengo L, et al. Evaluation of upper-extremity function following surgical treatment of displaced proximal humerus fractures in children. J Pediatr Orthop B. 2014;23(2):144-149.
[21]Sessa S, Lascombes P, Prevot J, et al. Centro-medullary nailing in fractures of the upper end of the humerus in children and adolescents. Chir Pediatr. 1990;31(1):43-46.
[22]Higgins J, Green S (Editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011, Available from www.cochrane-handbook.org.
[23]Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996; 17(1):1-12.
[24]Ga Shea BW, O'connell D. The Newcastle-Ottawa Scale(NOS) for assessing the quality of nonrandomized studies in meta-analyses, URL:http://www.ohri.ca/programs/clinical_ epidemiology/oxford.asp.
[25]Constant CR, Murley HG. A clinical method of functional assessment of shoulder. Clin Orthop. 1987;214:160-164.
[26]程少文,王伟,林忠勤,等.弹性髓内钉与锁定钢板内固定治疗儿童肱骨骨折的疗效比较[J]. 中国中医骨伤科杂志, 2010, 18(11): 26-28.
[27]李德欣.弹性髓内钉与锁定钢板内固定治疗儿童肱骨骨折的疗效比较[J]. 中国当代医药, 2013, 20(19):22-23.
[28]于跃波.弹性髓内钉与锁定钢板内固定治疗儿童肱骨骨折的疗效比较[J]. 医学信息, 2014, 28(5):156-156,157.
[29]赵学寨.弹性髓内钉与接骨板治疗大龄儿童肱骨干骨折的对比研究[J].临床和实验医学杂志, 2014, 13(11):948-950.
[30]杜星男.弹性髓内钉与锁定钢板内固定治疗儿童肱骨骨折的疗效比较[J].中国保健营养(下旬刊), 2013, 23(11):6352.