Li Y, Luo Y, Peng J, Fan J, Long XT. Clinical effect of operative vs nonoperative treatment on humeral shaft fractures: Systematic review and meta-analysis of clinical trials. World J Orthop 2024; 15(8): 783-795 [DOI: 10.5312/wjo.v15.i8.783]
Corresponding Author of This Article
Jing Peng, MD, Surgeon, Department of Traumatic Orthopedics, Chongqing General Hospital, Chongqing University, No. 118 Xingguang Avenue, Liangjiang New Area, Chongqing 401147, China. pengjing320@foxmail.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Systematic Reviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Aug 18, 2024; 15(8): 783-795 Published online Aug 18, 2024. doi: 10.5312/wjo.v15.i8.783
Clinical effect of operative vs nonoperative treatment on humeral shaft fractures: Systematic review and meta-analysis of clinical trials
Yang Li, Yi Luo, Jing Peng, Jun Fan, Xiao-Tao Long
Yang Li, Jing Peng, Jun Fan, Xiao-Tao Long, Department of Traumatic Orthopedics, Chongqing General Hospital, Chongqing University, Chongqing 401147, China
Yi Luo, Department of Orthopedics, Bishan Hospital of Chongqing, Chongqing 402760, China
Co-first authors: Yang Li and Yi Luo.
Author contributions: Li Y and Luo Y contributed to equally; Peng J conceived the design of the study and prepared the manuscript; Li Y and Luo Y finished the literature search and data extraction; Fan J and Long XT assessed the methodological quality; Li Y, and Luo Y contributed to data analysis and wrote the manuscript; All authors have read and approved the final manuscript.
Supported byNatural Science Foundation of Chongqing, China, No. CSTB2023NSCQ-MSX1080.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jing Peng, MD, Surgeon, Department of Traumatic Orthopedics, Chongqing General Hospital, Chongqing University, No. 118 Xingguang Avenue, Liangjiang New Area, Chongqing 401147, China. pengjing320@foxmail.com
Received: March 23, 2024 Revised: June 5, 2024 Accepted: July 11, 2024 Published online: August 18, 2024 Processing time: 142 Days and 17.8 Hours
Abstract
BACKGROUND
Whether operation is superior to non-operation for humeral shaft fracture remains debatable. We hypothesized that operation could decrease the nonunion and reintervention rates and increase the functional outcomes.
AIM
To compare the clinical efficacy between operative and nonoperative approaches for humeral shaft fractures.
METHODS
We searched the PubMed, Web of Science, ScienceDirect, and Cochrane databases from 1990 to December 2023 for clinical trials and cohort studies comparing the effects of operative and conservative methods on humeral shaft fractures. Two investigators independently extracted data from the eligible studies, and the other two assessed the methodological quality of each study. The quality of the included studies was assessed using the Cochrane risk bias or Newcastle-Ottawa Scale. The nonunion, reintervention and the overall complications and functional scores were pooled and analyzed using Review Manager software (version 5.3).
RESULTS
A total of four randomized control trials and 13 cohort studies were included, with 1285 and 1346 patients in the operative and nonoperative groups, respectively. Patients in the operative group were treated with a plate or nail, whereas those in the conservative group were managed with splint or functional bracing. Four studies were assessed as having a high risk of bias, and the other 13 were of a low risk of bias according to the Newcastle-Ottawa Scale or Cochrane risk bias tool. The operative group had a significantly decreased rate of nonunion [odds ratio (OR) 0.30; 95%CI: 0.23 to 0.40), reintervention (OR: 0.33; 95%CI: 0.24 to 0.47), and overall complications (OR: 0.62; 95%CI: 0.49 to 0.78)]. The pooled effect of the Disabilities of Arm, Shoulder, and Hand score showed a significant difference at 3 [mean difference (MD) -8.26; 95%CI: -13.60 to -2.92], 6 (MD: -6.72; 95%CI: -11.34 to -2.10), and 12 months (MD: -2.55; 95%CI: -4.36 to -0.74). The pooled effect of Visual Analog Scale scores and the Constant-Murley score did not significantly differ between the two groups.
CONCLUSION
This systematic review and meta-analysis revealed a trend of rapid functional recovery and decreased rates of nonunion and reintervention after operation for humeral shaft fracture compared to conservative treatment.
Core Tip: Whether operation is superior to non-operation for humeral shaft fracture remains debatable. This systematic review was conducted to investigate the effect of the two methods in terms of nonunion, reintervention, overall complications, and functional scores. The results revealed that lower rates of nonunion, reintervention, overall complications, and faster functional recovery could be achieved with operative treatment. This approach is significantly useful for clinicians in therapy decision-making.
