Conservative Management with Functional Brace Versus Various Surgical Fixation Techniques for Humeral Shaft...

Area of Science:

• Orthopedic surgery
• Traumatology

Background:

• Humeral shaft fractures have historically been managed nonoperatively with functional bracing.
• Surgical interventions are also available, prompting a comparison of treatment outcomes.

Purpose of the Study:

• To compare the outcomes of nonoperative versus operative interventions for extra-articular humeral shaft fractures.

Main Methods:

• Network meta-analysis of 21 randomized controlled trials (RCTs) involving 1,203 patients.
• Compared functional bracing with surgical techniques: ORIF, MIPO, aIMN, and rIMN.
• Assessed outcomes including time to union, nonunion, malunion, delayed union, secondary surgery, radial nerve palsy, and infection.

Main Results:

• Functional bracing showed higher nonunion and longer time to union than ORIF, MIPO, and aIMN.
• MIPO offered faster union than ORIF; functional bracing had higher malunion and delayed union rates than ORIF and aIMN, respectively.
• Functional bracing required more secondary surgical interventions; ORIF had higher rates of iatrogenic radial nerve injury and infection than bracing and MIPO.

Conclusions:

• Most operative interventions for humeral shaft fractures result in lower reoperation rates than functional bracing.
• Minimally invasive plate osteosynthesis (MIPO) provides faster union with less periosteal stripping.
• Open reduction and internal fixation (ORIF) is linked to higher radial nerve palsy rates, while nonoperative bracing often necessitates conversion to surgery.