Intramedullary Nail vs. Plate Fixation for Pathological Humeral Shaft Fracture: An Updated Narrative Review and Meta-Analysis of Surgery-Related Factors

Bing Kuan Chen, Ting Han Tai, Shu Hsuan Lin, Kuan Hao Chen, Yu Min Huang, Chih Yu Chen

Research output: Contribution to journalReview articlepeer-review

Abstract

(1) Background: Pathological humeral shaft fracture (PHSF) is a frequently observed clinical manifestation in the later stages of tumor metastasis. Surgical interventions are typically recommended to alleviate pain and restore functionality. Intramedullary nail fixation (INF) or plate fixation (PF) is currently recommended for the treatment of PHSF. However, there is still no standard for optimal surgical treatment. Thus, we conducted a meta-analysis comparing the clinical outcomes of INF with PF for PHSF treatment. (2) Methods: We conducted searches in databases, such as Scopus, EMBASE, and PubMed, for studies published prior to May 2023. In total, nine studies with 485 patients were reviewed. (3) Results: There were no significant differences noted in the incidence of fixation failure, local recurrence, wound complication or overall complication. However, the INF group demonstrated a significantly lower incidence of postoperative radial nerve palsy than the PF group (OR, 5.246; 95% CI, 1.548–17.774; p = 0.008). A subgroup analysis indicated that there were no statistically significant differences in fixation failure or local recurrence among subgroups categorized by the design of intramedullary nail. (4) Conclusions: Considering the short life expectancy of end-stage patients, the choice of surgical method depends on the patient’s individual condition, fracture and lesion patterns, the surgeon’s experience, and comprehensive discussion between the surgeon and patient.

Original languageEnglish
Article number755
JournalJournal of Clinical Medicine
Volume13
Issue number3
DOIs
Publication statusPublished - Feb 2024

Keywords

  • bone metastasis
  • internal fixation
  • intramedullary nail
  • meta-analysis
  • metastatic lesion
  • pathological humeral shaft fractures
  • plate

ASJC Scopus subject areas

  • General Medicine

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