Clinical effect of operative vs nonoperative treatment on humeral shaft fractures:Systematic review and meta-analysis of clinical trials  

作　　者：Yang Li Yi Luo Jing Peng Jun Fan Xiao-Tao Long 

机构地区：[1]Department of Traumatic Orthopedics,Chongqing General Hospital,Chongqing University,Chongqing 401147,China [2]Department of Orthopedics,Bishan Hospital of Chongqing,Chongqing 402760,China

出　　处：《World Journal of Orthopedics》2024年第8期783-795,共13页世界骨科杂志（英文版）

基　　金：Supported by Natural Science Foundation of Chongqing,China,No.CSTB2023NSCQ-MSX1080.

摘　　要：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 revie

关 键 词：Humeral shaft fracture Operation Nonoperation BRACE Systematic review 

分 类 号：R687.3[医药卫生—骨科学]