Bryan J M van de Wall1, Yassine Ochen2, Frank J P Beeres3, Reto Babst3, Björn C Link3, Marilyn Heng4, Detlef van der Velde5, Matthias Knobe3, Rolf H H Groenwold6, Marijn R Houwert2. 1. Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Luzern, Switzerland; Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: bryan_vdwall@hotmail.com. 2. Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. 3. Department of Orthopedic and Trauma Surgery, Lucerne Cantonal Hospital, Luzern, Switzerland. 4. Department of Orthopedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital Boston, Boston, MA, USA. 5. Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands. 6. Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
Abstract
BACKGROUND: This meta-analysis aimed to compare conservative vs. operative treatment for humeral shaft fractures in terms of the nonunion rate, reintervention rate, permanent radial nerve palsy rate, and functional outcomes. Secondarily, effect estimates from observational studies were compared with estimates of randomized clinical trials (RCTs). METHODS: The PubMed/Medline, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases were searched for both RCTs and observational studies comparing conservative with operative treatment for humeral shaft fractures. RESULTS: A total of 2 RCTs (150 patients) and 10 observational studies (1262 patients) were included. The pooled nonunion rate of all studies was higher in patients treated conservatively (15.3%) vs. operatively (6.4%) (risk difference, 8%; odds ratio [OR], 2.9; 95% confidence interval [CI], 1.8-4.5; I2 = 0%). The reintervention rate was also higher for conservative treatment (14.3%) than for operative treatment (8.9%) (risk difference, 6%; OR, 1.9; 95% CI, 1.1-3.5; I2 = 30%). The higher reintervention rate was predominantly attributable to the higher nonunion rate in patients treated conservatively. The permanent radial nerve palsy rate was equal in both groups (OR, 0.6; 95% CI, 0.2-1.9; I2 = 18%). There appeared to be no difference in mean time to union and mean Disabilities of the Arm, Shoulder and Hand scores between the treatment groups. No difference was found between effect estimates form observational studies and RCTs. CONCLUSION: This systematic review shows that satisfactory results can be achieved with both conservative and operative management; however, operative treatment reduces the risk of nonunion compared with conservative treatment, with comparable reintervention rates (for indications other than nonunion). Furthermore, operative treatment results in a similar permanent radial nerve palsy rate, despite its inherent additional surgery-related risks. No difference in mean time-to-union and short-term functional results was detected.
BACKGROUND: This meta-analysis aimed to compare conservative vs. operative treatment for humeral shaft fractures in terms of the nonunion rate, reintervention rate, permanent radial nerve palsy rate, and functional outcomes. Secondarily, effect estimates from observational studies were compared with estimates of randomized clinical trials (RCTs). METHODS: The PubMed/Medline, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases were searched for both RCTs and observational studies comparing conservative with operative treatment for humeral shaft fractures. RESULTS: A total of 2 RCTs (150 patients) and 10 observational studies (1262 patients) were included. The pooled nonunion rate of all studies was higher in patients treated conservatively (15.3%) vs. operatively (6.4%) (risk difference, 8%; odds ratio [OR], 2.9; 95% confidence interval [CI], 1.8-4.5; I2 = 0%). The reintervention rate was also higher for conservative treatment (14.3%) than for operative treatment (8.9%) (risk difference, 6%; OR, 1.9; 95% CI, 1.1-3.5; I2 = 30%). The higher reintervention rate was predominantly attributable to the higher nonunion rate in patients treated conservatively. The permanent radial nerve palsy rate was equal in both groups (OR, 0.6; 95% CI, 0.2-1.9; I2 = 18%). There appeared to be no difference in mean time to union and mean Disabilities of the Arm, Shoulder and Hand scores between the treatment groups. No difference was found between effect estimates form observational studies and RCTs. CONCLUSION: This systematic review shows that satisfactory results can be achieved with both conservative and operative management; however, operative treatment reduces the risk of nonunion compared with conservative treatment, with comparable reintervention rates (for indications other than nonunion). Furthermore, operative treatment results in a similar permanent radial nerve palsy rate, despite its inherent additional surgery-related risks. No difference in mean time-to-union and short-term functional results was detected.
Authors: Frank J P Beeres; Nicole van Veelen; Roderick Marijn Houwert; Björn C Link; Marilyn Heng; Matthias Knobe; Rolf H H Groenwold; Reto Babst; Bryan J M van de Wall Journal: Eur J Trauma Emerg Surg Date: 2022-03-11 Impact factor: 2.374
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Authors: Ingmar F Rompen; Matthias Knobe; Bjoern-Christian Link; Frank J P Beeres; Ralf Baumgaertner; Nadine Diwersi; Filippo Migliorini; Sven Nebelung; Reto Babst; Bryan J M van de Wall Journal: PLoS One Date: 2021-06-15 Impact factor: 3.240
Authors: Frank Joseph Paulus Beeres; Nicole van Veelen; Roderick Marijn Houwert; Björn Christian Link; Marilyn Heng; Matthias Knobe; Rolf Hendrik Herman Groenwold; Reto Babst; Bryan Joost Marinus van de Wall Journal: Eur J Trauma Emerg Surg Date: 2021-07-05 Impact factor: 2.374