Humeral shaft fractures

Summary

Evidence from three randomized controlled trials suggests that treatment of acute humeral shaft fractures with intramedullary nailing (IMN) compared with dynamic compression plating leads to comparable results with respect to rates of nounion, infection, and iatrogenic nerve injury. There appeared to be an increase in risk of reoperation with IMN, which was significant when data were pooled across studies. There was conflicting evidence in regard to the mean time to union. Additional methodologically rigorous randomized controlled trials with larger populations are necessary to establish the long term safety and efficacy of these two operative treatments and to evaluate the superiority of one treatment over another. One researcher [Bhandari] estimates that such a trial would require between 1150 and 2180 patients to have sufficient power to demonstrate a 25% relative risk reduction for reoperation [see appendix].