Introduction
Materials and methods
Search strategy
Database searched | Via | Query | Records | Records after duplicates removed |
---|---|---|---|---|
Embase | Embase.com | ((('humerus fracture'/de OR 'humerus shaft fracture'/de OR 'forearm fracture'/de) NOT (proximal OR distal):ab,ti,kw) OR (((humeral-shaft* OR humerus-shaft* OR forearm-shaft* OR arm-shaft*) NEAR/3 (fracture*))):ab,ti,kw) AND (surgery/exp OR surgery:lnk OR 'orthopedic fixation device'/exp OR 'bone plate'/de OR 'conservative treatment'/exp OR brace/de OR 'plaster cast'/de OR splinting/de OR immobilization/exp OR (surg* OR operat* OR nailing OR nails OR pins OR plate* OR plating OR (extern* NEAR/3 fix*) OR screw* OR conservative* OR brace* OR bracing OR sling* OR plaster* OR cast OR casting OR nonoperat* OR nonsurg* OR Sarmiento OR splint* OR traction OR immobili*):ab,ti,kw) NOT ((animal/exp OR animal*:de OR nonhuman/de) NOT ('human'/exp)) NOT ([Conference Abstract]/lim) NOT ('child'/exp NOT ('adult'/exp OR 'adolescent'/de)) | 5809 | 5769 |
Medline ALL | Ovid | ((("Humeral Fractures"/) NOT (proximal OR distal).ab,ti,kf.) OR (((humer* OR forearm OR arm) ADJ3 shaft* ADJ3 fracture*)).ab,ti,kf.) AND (surgery.xs. OR exp "Orthopedic Fixation Devices"/ OR braces/ OR immobilization/ OR (surg* OR operat* OR nailing OR nails OR pins OR plate* OR plating OR (extern* ADJ3 fix*) OR screw* OR conservative* OR brace* OR bracing OR sling* OR plaster* OR cast OR casting OR nonoperat* OR nonsurg* OR Sarmiento OR splint* OR traction OR immobili*).ab,ti,kf.) NOT (exp Animals/ NOT Humans/) NOT (news OR congres* OR abstract* OR book* OR chapter* OR dissertation abstract*).pt. NOT ((exp Child/ OR exp Infant/) NOT (exp Adult/ OR exp Adolescent/)) | 2975 | 861 |
Web of Science Core Collection | Web of Knowledge | TS = ((((humer* OR forearm OR arm) NEAR/3 shaft* NEAR/3 fracture*)) AND ((surg* OR operat* OR nailing OR nails OR pins OR plate* OR plating OR (extern* NEAR/3 fix*) OR screw* OR conservative* OR brace* OR bracing OR sling* OR plaster* OR cast OR casting OR nonoperat* OR nonsurg* OR Sarmiento OR splint* OR traction OR immobili*)) NOT ((child* OR infan* OR pediatric*) NOT (adult* OR elderly* OR geriatric*)) NOT ((animal* OR rat OR rats OR mouse OR mice OR murine OR dog OR dogs OR canine OR cat OR cats OR feline OR rabbit OR cow OR cows OR bovine OR rodent* OR sheep OR ovine OR pig OR swine OR porcine OR veterinar* OR chick* OR zebrafish* OR baboon* OR nonhuman* OR primate* OR cattle* OR goose OR geese OR duck OR macaque* OR avian* OR bird* OR fish*) NOT (human* OR patient* OR women OR woman OR men OR man))) AND DT = (Article OR Review OR Letter OR Early Access) | 749 | 91 |
Cochrane Central Register of Controlled Trials | Wiley | (((humer* OR forearm OR arm) NEAR/3 shaft* NEAR/3 fracture*)):ab,ti,kw AND ((surg* OR operat* OR nailing OR nails OR pins OR plate* OR plating OR (extern* NEAR/3 fix*) OR screw* OR conservative* OR brace* OR bracing OR sling* OR plaster* OR cast OR casting OR nonoperat* OR nonsurg* OR Sarmiento OR splint* OR traction OR immobili*):ab,ti,kw) NOT ((child* OR infan* OR pediatric*) NOT (adult* OR elderly* OR geriatric*)):ab,ti,kw | 92 | 33 |
Total | 9625 | 6754 |
Eligibility criteria
Study selection
Data collection and data items
Risk of bias assessment
Statistical analysis
Results
Study selection
Study characteristics
Risk of bias assessment
Fracture healing—time to union
Treatment | Study arms | Population | Cases | Heterogeneity | Pooled value | ||
---|---|---|---|---|---|---|---|
N | N | N | Cochran’s Q (p value) | I2 (%) (95% CI) | (95% CI) | ||
Non-operative | 5 | 286 | N.A | 60 (< 0.001) | 93 (87–97) | 16.4 (14.4–18.4) | |
IMN | 21 | 819 | N.A | 977 (< 0.001) | 98 (98–98) | 13.8 (12.5–15.1) | |
Antegrade | 17 | 654 | N.A | 777 (< 0.001) | 98 (97–98) | 13.8 (12.4–15.2) | |
Retrograde | 3 | 87 | N.A | 56 (< 0.001) | 96 (92–98) | 12.4 (9.1–15.8) | |
Plate | 41 | 1392 | N.A | 1555 (< 0.001) | 97 (97–98) | 15.4 (14.4–16.4) | |
ORPO | 31 | 1194 | N.A | 1416 (< 0.001) | 98 (98–98) | 15.8 (14.7–17.0) | |
MIPO | 10 | 198 | N.A | 101 (< 0.001) | 91 (86–94) | 14.1 (12.2–15.9) | |
Non-operative | 26 | 1979 | 1770 | 193 (< 0.001) | 87 (82–91) | 89 (84–92) | |
IMN | 73 | 2990 | 2811 | 156 (< 0.001) | 54 (40–65) | 94 (92–95) | |
Antegrade | 55 | 2195 | 2060 | 88 (< 0.001) | 39 (15–56) | 94 (92–95) | |
Retrograde | 8 | 265 | 255 | 9 (0.221) | 26 (0–67) | 94 (91–97) | |
Plate | 136 | 5226 | 5030 | 227 (< 0.001) | 41 (27–52) | 96 (95–97) | |
ORPO | 91 | 3896 | 3728 | 171 (< 0.001) | 47 (33–59) | 96 (95–96) | |
MIPO | 45 | 1330 | 1302 | 46 (0.394) | 4 (0–31) | 98 (97–98) | |
Non-operative | 24 | 1959 | 182 | 175 (< 0.001) | 87 (82–91) | 11 (7–15) | |
IMN | 70 | 2787 | 156 | 106 (< 0.001) | 35 (12–51) | 6 (5–7) | |
Antegrade | 55 | 2181 | 127 | 80 (0.013) | 32 (5–51) | 6 (5–8) | |
Retrograde | 7 | 238 | 10 | 7 (0.278) | 20 (0–64) | 5 (2–8) | |
Plate | 129 | 5098 | 163 | 205 (< 0.001) | 37 (22–50) | 3 (3–4) | |
ORPO | 88 | 3865 | 139 | 167 (< 0.001) | 48 (33–60) | 4 (3–5) | |
MIPO | 41 | 1233 | 24 | 33 (0.764) | 0 (0–23) | 2 (2–3) | |
Non-operative | 11 | 486 | 34 | 48 (< 0.001) | 79 (63–88) | 6 (2–12) | |
IMN | 22 | 798 | 23 | 53 (< 0.001) | 61 (37–75) | 3 (1–5) | |
Antegrade | 17 | 555 | 20 | 50 (< 0.001) | 68 (47–81) | 3 (1–6) | |
Retrograde | 1 | N.A | N.A | N.A | N.A | 0 (0–4) | |
Plate | 59 | 1939 | 15 | 29 (1.000) | 0 (0–0) | 1 (1–2) | |
ORPO | 37 | 1293 | 6 | 11 (1.000) | 0 (0–0) | 1 (1–2) | |
MIPO | 22 | 646 | 9 | 15 (0.805) | 0 (0–26) | 2 (1–3) |
Fracture healing rate
Fracture healing—nonunion
Fracture healing—malunion
Complications—radial nerve palsy
Treatment | Study arms | Population | Cases | Heterogeneity | Pooled value | ||||
---|---|---|---|---|---|---|---|---|---|
N | N | N | Cochran’s Q (p value) | I2 (%) (95% CI) | (%) (95% CI) | ||||
Non-operative | 23 | 1739 | 142 | 24 (0.364) | 7 (0–40) | 8 (7–10) | |||
IMN | 44 | 1933 | 116 | 172 (< 0.001) | 75 (67–81) | 6 (4–8) | |||
Antegrade | 31 | 1255 | 74 | 148 (< 0.001) | 80 (72–85) | 5 (3–8) | |||
Retrograde | 6 | 213 | 11 | 8 (0.166) | 36 (0–75) | 5 (3–9) | |||
Plate | 85 | 3371 | 291 | 494 (< 0.001) | 83 (79–86) | 6 (4–8) | |||
ORPO | 62 | 2603 | 29 | 398 (< 0.001) | 85 (81–88) | 7 (4–9) | |||
MIPO | 23 | 768 | 262 | 65 (< 0.001) | 66 (48–78) | 4 (2–7) | |||
Non-operative | 19 | 1377 | 10 | 36 (0.001) | 50 (15–71) | 1 (0–2) | |||
IMN | 62 | 2576 | 66 | 81 (0.044) | 25 (0–45) | 3 (2–3) | |||
Antegrade | 47 | 1872 | 39 | 57 (0.121) | 20 (0–45) | 2 (2–3) | |||
Retrograde | 7 | 224 | 8 | 3 (0.751) | 0 (0–50) | 4 (2–8) | |||
Plate | 136 | 5524 | 318 | 348 (< 0.001) | 61 (53–68) | 6 (5–7) | |||
ORPO | 92 | 4232 | 275 | 287 (< 0.001) | 68 (61–74) | 7 (6–9) | |||
MIPO | 44 | 1292 | 43 | 49 (0.250) | 12 (0–40) | 4 (3–5) | |||
Non-operative | N.A | N.A | N.A | N.A | N.A | N.A | |||
IMN | 40 | 1489 | 59 | 180 (< 0.001) | 78 (71–84) | 5 (3–8) | |||
Antegrade | 27 | 872 | 33 | 62 (< 0.001) | 58 (35–73) | 4 (2–6) | |||
Retrograde | 6 | 202 | 10 | 13 (< 0.001) | 63 (9–85) | 5 (1–11) | |||
Plate | 43 | 1868 | 6 | 25 (0.980) | 0 (0–0) | 1 (0–1) | |||
ORPO | 29 | 1409 | 4 | 18 (0.933) | 0 (0–7) | 1 (0–1) | |||
MIPO | 14 | 459 | 2 | 7 (0.897) | 0 (0–18) | 1 (0–2) | |||
Non-operative | N.A | N.A | N.A | N.A | N.A | N.A | |||
IMN | 28 | 1034 | 51 | 48 (< 0.001) | 44 (12–64) | 4 (3–6) | |||
Antegrade | 20 | 668 | 31 | 41 (< 0.001) | 54 (23–72) | 4 (2–6) | |||
Retrograde | 3 | 128 | 8 | 3 (0.232) | 32 (0–98) | 7 (3–12) | |||
Plate | 71 | 2839 | 40 | 88 (0.076) | 20 (0–41) | 2 (1–2) | |||
ORPO | 50 | 2300 | 31 | 67 (0.043) | 27 (0–49) | 2 (1–3) | |||
MIPO | 21 | 539 | 9 | 19 (0.515) | 0 (0–45) | 2 (1–4) | |||
Infectione | Non-operative | 9 | 462 | 3 | 6 (0.685) | 0 (0–51) | 1 (0–2) | ||
IMN | 60 | 2416 | 34 | 71 (0.143) | 16 (0–40) | 2 (1–2) | |||
Antegrade | 48 | 1863 | 28 | 63 (0.059) | 25 (0–48) | 2 (1–2) | |||
Retrograde | 6 | 235 | 2 | 5 (0.431) | 0 (0–75) | 1 (0–3) | |||
Plate | 117 | 5108 | 124 | 193 (< 0.001) | 40 (25–52) | 3 (2–3) | |||
ORPO | 83 | 3982 | 116 | 158 (< 0.001) | 48 (33–60) | 3 (3–4) | |||
MIPO | 34 | 1126 | 8 | 22 (0.934) | 0 (0–7) | 1 (1–2) |
Complications—intraoperative complications
Complications—implant-related complications
Complications—infection
Complications—shoulder dysfunction
Complications—nail protrusion
Complications—subacromial impingement
Complications—(sub)cutaneous problems
Range of motion
Study arms | Population | Heterogeneity | Pooled value | |||
---|---|---|---|---|---|---|
N | N | Cochran’s Q (p value) | I2 (%) (95% CI) | (degrees) (95% CI) | ||
Non-operative | 0 | N.A | N.A | N.A | N.A | |
IMN | 2 | 34 | 309 (< 0.001) | 100 (99–100) | 132 (76–189) | |
Antegrade | 2 | 34 | 309 (< 0.001) | 100 (99–100) | 132 (76–189) | |
Retrograde | 0 | N.A | N.A | N.A | N.A | |
Plate | 9 | 194 | 25,064 (< 0.001) | 100 (100–100) | 151 (116–186) | |
ORPO | 8 | 146 | 19,692 (< 0.001) | 100 (100–100) | 148 (111–186) | |
MIPO | 1 | N.A | N.A | N.A | N.A | |
Non-operative | 0 | N.A | N.A | N.A | N.A | |
IMN | 2 | 34 | 181 (< 0.001) | 100 (99–100) | 120 (33–207) | |
Antegrade | 2 | 34 | 181 (< 0.001) | 100 (99–100) | 120 (33–207) | |
Retrograde | 0 | N.A | N.A | N.A | N.A | |
Plate | 14 | 289 | 5444 (< 0.001) | 100 (100–100) | 148 (137–160) | |
ORPO | 10 | 181 | 5202 (< 0.001) | 100 (100–100) | 141 (124–158) | |
MIPO | 4 | 108 | 24 (< 0.001) | 87 (70–95) | 167 (164–171) |
Functional outcome—DASH
Instrument | Treatment | Study arms | Population | Heterogeneity | Pooled value | |
---|---|---|---|---|---|---|
N | N | Cochran’s Q (p value) | I2 (%) (95% CI) | (points) (95% CI) | ||
Non-operative | 3 | 114 | 141 (< 0.001) | 99 (98–99) | 17 (3–31) | |
IMN | 5 | 192 | 181 (< 0.001) | 98 (97–99) | 23 (17–29) | |
Antegrade | 5 | 192 | 181 (< 0.001) | 98 (97–99) | 23 (17–29) | |
Retrograde | 0 | N.A | N.A | N.A | N.A | |
Plate | 13 | 378 | 1292 (< 0.001) | 99 (99–99) | 13 (8–19) | |
ORPO | 9 | 280 | 936 (< 0.001) | 99 (99–99) | 17 (9–24) | |
MIPO | 4 | 98 | 97 (< 0.001) | 97 (94–98) | 7 (1–13) | |
Non-operative | 1 | N.A | N.A | N.A | N.A | |
IMN | 9 | 499 | 2071 (< 0.001) | 100 (100–100) | 90 (85–95) | |
Antegrade | 7 | 440 | 375 (< 0.001) | 98 (98–99) | 89 (85–93) | |
Retrograde | 2 | 23 | N.A | N.A | N.A | |
Plate | 13 | 569 | 199 (< 0.001) | 94 (91–96) | 93 (92–95) | |
Open | 10 | 295 | 147 (< 0.001) | 94 (91–96) | 93 (91–95) | |
MIPO | 3 | 274 | 48 (< 0.001) | 96 (91–98) | 93 (89–97) | |
Non-operative | 0 | N.A | N.A | N.A | N.A | |
IMN | 2 | 49 | 17 (< 0.001) | 94 (81–98) | 28 (22–34) | |
Antegrade | 2 | 49 | 17 (< 0.001) | 94 (81–98) | 28 (22–34) | |
Retrograde | 0 | N.A | N.A | N.A | N.A | |
Plate | 15 | 501 | 385 (< 0.001) | 96 (95–97) | 33 (32–33) | |
Open | 8 | 346 | 311 (< 0.001) | 98 (97–98) | 32 (32–33) | |
MIPO | 7 | 155 | 69 (< 0.001) | 91 (85–95) | 33 (32–34) |