Fragility of statistically significant findings from randomized clinical trials of surgical treatment of humeral shaft fractures: A systematic review

doi:10.5312/wjo.v13.i9.825

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 13, Issue 9

This Article

Academic Content and Language Evaluation of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Number of Hits and Downloads for This Article

Total Article Views (4314)

All Articles published online

The chart showing PDF series, WORD series, HTML series, Figures (1-3) series, Tables (1-4) series.

Item

Count

PDF

184

WORD

HTML

2145

Figures (1-3)

243

Tables (1-4)

194

Sum=2797

Featured Article

The chart showing Browse series, Download series.

Item

Count

Browse

191

Download

443

Sum=634

Publishing Process of This Article

Item

Count

Browse

293

Download

590

Sum=883

Sep 18, 2022 (publication date) through Jan 6, 2025

Times Cited of This Article

Times Cited (7)

Journal Information of This Article

Publication Name

World Journal of Orthopedics

ISSN

2218-5836

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Systematic Reviews

World J Orthop. Sep 18, 2022; 13(9): 825-836
Published online Sep 18, 2022. doi: 10.5312/wjo.v13.i9.825

Table 1 Included randomized controlled trials with characteristics

First author (last name)	Journal	Year	Comparison	Patients enrolled	Patients lost to follow up	Final study, n	JADAD score	Power analysis
Kim	J Orthop Trauma	2015	ORPO (LCP) vs MIPO	72	4	68	3	Yes
Esmailiejah	Trauma Mon	2015	ORPO (DCP) vs MIPO	68	3	65	3	No
Fan	Orthopedics	2015	ORPO (LCP) vs IMN	60	0	60	2	Yes
Hadhoud	Menoufia Medical Journal	2015	ORPO (LCP) vs MIPO	30	0	30	2	No
Wali	Strategies Trauma Limb Reconstr	2014	ORPO (DCP) vs IMN	50	0	50	2	No
Benegas	J Shoulder Elbow Surg	2014	MIPO vs IMN	41	1	40	3	Yes
Lian	Orthopedics	2013	MIPO vs IMN	56	9	47	3	No
Li	J Shoulder Elbow Surg	2011	ORPO (LCP) vs IMN	50	5	45	3	Yes
Iqbal	Annals of King Edward Medical University	2011	ORPO (DCP) vs IMN	40	0	40	3	No
Singisetti	Int Orthop	2010	ORPO (DCP) vs IMN	45	9	36	1	No
Putti	J Orthop Surg (Hong Kong)	2009	ORPO (DCP) vs IMN	34	0	34	2	No
Changulani	Int Orthop	2007	ORPO (DCP) vs IMN	47	2	45	3	No
Kesemenli	Acta Orthop Traumatol Turc	2003	ORPO (DCP) vs IMN	60	0	60	2	No
McCormack	J Bone Joint Surg (Br)	2000	ORPO (DCP) vs IMN	44	3	41	2	No
Chapman	J Orthop Trauma	2000	ORPO (DCP) vs IMN	89	5	84	3	No

ORPO: Open reduction and plate osteosynthesis; DCP: Dynamic compression plate; LCP: Locking compression plate; IMN: Intramedullary nail; MIPO: Minimally invasive plate osteosynthesis.

Table 2 Summary characteristics of included randomized controlled trials

Characteristic	No.	% or range
Initial sample size, mean No.	52.4	(30-89)
Lost to follow up, mean No.	2.7	(0-9)
Final sample size, mean No.	49.7	(30-84)
Power analysis	4	26.7%
Comparison groups
ORPO (DCP) vs IMN	8	53.3%
ORPO (LCP) vs IMN	2	13.3%
MIPO vs IMN	2	13.3%
ORPO (LCP) vs MIPO	2	13.3%
ORPO (DCP) vs MIPO	1	6.7%
Outcome assessed
Delayed union/nonunion	15	100.0%
Iatrogenic radial nerve palsy	15	100.0%
Infection	14	93.3%
Secondary surgeries	11	73.3%
Shoulder impingement	10	66.7%
Malunion	7	46.7%
Elbow stiffness	4	26.7%

ORPO: Open reduction and plate osteosynthesis; DCP: Dynamic compression plate; LCP: Locking compression plate; IMN: Intramedullary nail; MIPO: Minimally invasive plate osteosynthesis.

Table 3 Fragility index values for each outcome for included randomized controlled trials

First author (last name)	Comparison	Delayed union/ Nonunion	Iatrogenic radial nerve palsy	Infection	Malunion	Shoulder Impingement	Elbow Stiffness	All complications	Secondary surgeries
Kim	ORPO (LCP) vs MIPO	0	0	0	0	NA	NA	0	0
Esmailiejah	ORPO (DCP) vs MIPO	0	0	0	0	NA	NA	0	0
Fan	ORPO (LCP) vs IMN	0	0	NA	NA	NA	NA	0	NA
Hadhoud	ORPO (LCP) vs MIPO	0	0	0	NA	NA	NA	0	NA
Wali	ORPO (DCP) vs IMN	0	0	0	NA	0	0	0	0
Benegas	MIPO vs IMN	0	0	0	0	0	NA	0	0
Lian	MIPO vs IMN	0	0	0	0	1	0	4	NA
Li	ORPO (LCP) vs IMN	0	0	0	2	NA	NA	0	NA
Iqbal	ORPO (DCP) vs IMN	0	0	0	NA	0	NA	0	0
Singisetti	ORPO (DCP) vs IMN	0	0	0	NA	0	0	0	0
Putti	ORPO (DCP) vs IMN	0	0	0	NA	0	NA	0	0
Changulani	ORPO (DCP) vs IMN	0	0	0	NA	1	NA	0	0
Kesemenli	ORPO (DCP) vs IMN	0	1	0	NA	0	NA	0	0
McCormack	ORPO (DCP) vs IMN	0	0	0	0	2	NA	6	1
Chapman	ORPO (DCP) vs IMN	0	0	0	0	2	1	0	0

ORPO: Open reduction and plate osteosynthesis; DCP: Dynamic compression plate; LCP: Locking compression plate; IMN: Intramedullary nail; MIPO: Minimally invasive plate osteosynthesis.

Table 4 Summary of outcomes with reported differences between groups

Continuous variable	Superior treatment	Inferior treatment	First author (last name)
Time to union	IMN	ORPO	Changulani
Time to union	IMN	ORPO	Fan
Operative time	IMN	ORPO	Fan
Operative time	IMN	ORPO	Wali
Operative time	MIPO	IMN	Lian
Operative time	MIPO	ORPO	Hadhoud
Intraoperative blood loss	IMN	ORPO	Fan
Intraoperative blood loss	IMN	ORPO	Wali
Intraoperative blood loss	MIPO	IMN	Lian
Hospital stay	IMN	ORPO	Fan
Hospital stay	IMN	ORPO	Wali
Constant scores	MIPO	IMN	Li
Rodriguez-Merchan criteria	DCP	IMN	Singisetti
Shoulder ROM	MIPO	IMN	Li
Shoulder ROM	DCP	IMN	Chapman
Elbow ROM	IMN	DCP	Chapman

ORPO: Open reduction and plate osteosynthesis; DCP: Dynamic compression plate; LCP: Locking compression plate; IMN: Intramedullary nail; MIPO: Minimally invasive plate osteosynthesis.

Citation: Morris SC, Gowd AK, Agarwalla A, Phipatanakul WP, Amin NH, Liu JN. Fragility of statistically significant findings from randomized clinical trials of surgical treatment of humeral shaft fractures: A systematic review. World J Orthop 2022; 13(9): 825-836
URL: https://www.wjgnet.com/2218-5836/full/v13/i9/825.htm
DOI: https://dx.doi.org/10.5312/wjo.v13.i9.825