Different treatment for humeral shaft fractures: A network meta-analysis.

IF 1.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Medicine Pub Date : 2025-01-17 DOI:10.1097/MD.0000000000040948

Jiankuo Guo, Hua Ma

{"title":"Different treatment for humeral shaft fractures: A network meta-analysis.","authors":"Jiankuo Guo, Hua Ma","doi":"10.1097/MD.0000000000040948","DOIUrl":null,"url":null,"abstract":"Background: The main treatment methods for humeral shaft fractures include minimally invasive plate osteosynthesis (MIPO), intramedullary nailing (IMN), open reduction and internal fixation (ORF), and non-operative treatment (NonOP). However, the optimal treatment plan remains unclear. This article utilizes a network meta-analysis to compare the therapeutic effects of MIPO, IMN, ORF, and NonOP for the treatment of humeral shaft fractures.Methods: We searched electronic databases, including the PubMed, Embase, The Cochrane Library, and the Web of Science Databases, from inception to June 1, 2024. The \"Risk of Bias Assessment\" tool recommended by the Cochrane Collaboration was used to evaluate the quality of the included literature. RevMan 5.4 software and R software with gemtc package was used for the graphical representation and data analysis of the network meta-analysis.Results: A total of 23 randomized controlled trials were finally included. The results indicated that the efficacy of disabilities of the arm, shoulder and hand score was significantly higher in the MIPO group than in the open reduction and internal fixation (ORIF) group (weighted mean difference = 4.7, 95% confidence intervals, 1.8-7.75). IMN was associated with a decrease of the constant-Murley scores score than NonOP (weighted mean difference = -4.4, 95% confidence intervals, -8.7 to -0.068). IMN, MIPO, and ORIF was associated with a decrease of the fracture healing time than NonOP. The difference for nonunion rate and iatrogenic radial nerve injuries between any 2 groups was not statistically significant (P > .05).Conclusion: The evidence from current meta-analysis indicated that ORIF provides the best recovery effects for upper limb and shoulder joint function after the treatment of humeral shaft fractures, with the drawback of a relatively higher incidence of complications. To ensure the reliability of this study's results, more high-quality randomized controlled trials are needed in the future to verify these findings.","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 3","pages":"e40948"},"PeriodicalIF":1.3000,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749579/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/MD.0000000000040948","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}

引用次数: 0

Abstract

Background: The main treatment methods for humeral shaft fractures include minimally invasive plate osteosynthesis (MIPO), intramedullary nailing (IMN), open reduction and internal fixation (ORF), and non-operative treatment (NonOP). However, the optimal treatment plan remains unclear. This article utilizes a network meta-analysis to compare the therapeutic effects of MIPO, IMN, ORF, and NonOP for the treatment of humeral shaft fractures.

Methods: We searched electronic databases, including the PubMed, Embase, The Cochrane Library, and the Web of Science Databases, from inception to June 1, 2024. The "Risk of Bias Assessment" tool recommended by the Cochrane Collaboration was used to evaluate the quality of the included literature. RevMan 5.4 software and R software with gemtc package was used for the graphical representation and data analysis of the network meta-analysis.

Results: A total of 23 randomized controlled trials were finally included. The results indicated that the efficacy of disabilities of the arm, shoulder and hand score was significantly higher in the MIPO group than in the open reduction and internal fixation (ORIF) group (weighted mean difference = 4.7, 95% confidence intervals, 1.8-7.75). IMN was associated with a decrease of the constant-Murley scores score than NonOP (weighted mean difference = -4.4, 95% confidence intervals, -8.7 to -0.068). IMN, MIPO, and ORIF was associated with a decrease of the fracture healing time than NonOP. The difference for nonunion rate and iatrogenic radial nerve injuries between any 2 groups was not statistically significant (P > .05).

Conclusion: The evidence from current meta-analysis indicated that ORIF provides the best recovery effects for upper limb and shoulder joint function after the treatment of humeral shaft fractures, with the drawback of a relatively higher incidence of complications. To ensure the reliability of this study's results, more high-quality randomized controlled trials are needed in the future to verify these findings.

查看原文本刊更多论文

肱骨干骨折的不同治疗：网络荟萃分析。

背景：肱骨干骨折的主要治疗方法包括微创钢板内固定（MIPO）、髓内钉（IMN）、切开复位内固定（ORF）和非手术治疗（NonOP）。然而，最佳的治疗方案仍不清楚。本文采用网络meta分析比较了MIPO、IMN、ORF和NonOP治疗肱骨干骨折的疗效。方法：检索PubMed、Embase、the Cochrane Library、Web of Science数据库等电子数据库，检索时间从成立到2024年6月1日。采用Cochrane协作网推荐的“偏倚风险评估”工具评价纳入文献的质量。网络meta分析采用RevMan 5.4软件和带有gemtc软件包的R软件进行图形化表示和数据分析。结果：最终纳入23项随机对照试验。结果显示，MIPO组手臂、肩部和手部残疾评分的疗效明显高于切开复位内固定（ORIF）组（加权平均差值为4.7,95%可信区间为1.8 ~ 7.75）。与NonOP相比，IMN与constant-Murley评分降低相关（加权平均差= -4.4,95%可信区间为-8.7 ~ -0.068）。与NonOP相比，IMN、MIPO和ORIF与骨折愈合时间缩短有关。两组间骨不连率及医源性桡神经损伤的差异均无统计学意义（P < 0.05）。结论：目前meta分析的证据表明，ORIF治疗肱骨干骨折后上肢和肩关节功能恢复效果最好，但并发症发生率较高。为了保证本研究结果的可靠性，未来还需要更多高质量的随机对照试验来验证这些发现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Medicine 医学-医学：内科

CiteScore

2.80

自引率

0.00%

发文量

4342

审稿时长

>12 weeks

期刊介绍： Medicine is now a fully open access journal, providing authors with a distinctive new service offering continuous publication of original research across a broad spectrum of medical scientific disciplines and sub-specialties. As an open access title, Medicine will continue to provide authors with an established, trusted platform for the publication of their work. To ensure the ongoing quality of Medicine’s content, the peer-review process will only accept content that is scientifically, technically and ethically sound, and in compliance with standard reporting guidelines.