Summary
Evidence from four randomized controlled trials (RCT) 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 and infection.
There appeared to be an increase in risk of reoperation and iatrogenic nerve injury
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 references].
