Complications in humeral shaft fractures – non-union, iatrogenic radial nerve palsy, and postoperative infection: a systematic review and meta-analysis

Abstract

• The aim of this systematic review and meta-analysis was to assess risk for iatrogenic radial nerve palsy (iRNP), non-union, and post-operative infection in humeral shaft fractures.• A PubMed search including original articles comparing different treatments for humeralshaft fractures published since January 2000 was performed. Random effect models withrelative risks (RR) and 95% CIs were calculated for treatment groups and outcomes.• Of the 841 results, 43 studies were included in the meta-analysis (11 level II, 5 level III,27 level IV). Twenty-seven compared intramedullary nailing (IM) with ORIF, nineconservative with operative treatment, four ORIF with minimally invasive plateosteosynthesis (MIPO), and three anterior/anterolateral with posterior approach. iRNPrisk was higher for ORIF vs IM (18 studies; RR: 1.80; P = 0.047), ORIF vs MIPO (4 studies;RR: 5.60; P = 0.011), and posterior vs anterior/anterolateral approach (3 studies; RR: 2.68;P = 0.005). Non-union risk was lower for operative vs conservative therapy (six studies;RR: 0.37; P < 0.001), but not significantly different between ORIF and IM (21 studies; RR:1.00; P = 0.997), or approaches (two studies; RR: 0.36; P = 0.369). Post-operative infectionrisk was higher for ORIF vs IM (14 studies; RR: 1.84; P = 0.004) but not different betweenapproaches (2 studies; RR: 0.95; P = 0.960).• Surgery appears to be the method of choice when aiming to secure bony union, albeit riskfor iRNP has to be considered, particularly in case of ORIF vs IM or MIPO, and posteriorapproach. Due to the limited number of randomised studies, evidence on the besttreatment option remains moderate, though