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Interventions for humeral shaft fractures: mixed treatment comparisons of clinical trials

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Abstract

Summary

We designed a study to compare the efficacy of five main therapeutic options, including external fixation, open reduction and plate osteosynthesis (ORPO), minimally invasive plate osteosynthesis (MIPO), dynamic compression plate (DCP), and intramedullary nail (IMN) in treating humeral shaft fractures. Our results indicated that MIPO and IMN were recommended as the optimal treatments for clinical use.

Purpose

Nowadays, five main therapeutic options are used in treating humeral shaft fractures: external fixation, open reduction and plate osteosynthesis (ORPO), minimally invasive plate osteosynthesis (MIPO), dynamic compression plate (DCP), and intramedullary nail (IMN). Aiming to provide reliable evidence for clinical selection, we designed a network meta-analysis (NMA) to evaluate the efficacy of these treatments.

Methods

NMA was conducted on Bayesian framework with software R 3.3.2 and STATA 13.0. Nonunion rate, radial nerve palsy rate, union time, complication rate, and infection rate were considered as primary outcomes. Mean operation time was the secondary outcome. The outcomes were measured by odds ratio (OR) value and corresponding 95% credible intervals (CrIs) or mean difference (MD) with 95% CrIs. Surface under cumulative ranking curve (SUCRA) was calculated to show the ranking probability of each treatment.

Results

Our results indicated that ORPO had a higher risk of radial nerve palsy than MIPO (OR = 2.83, 95% CrIs = 1.28–6.23), and DCP had a better performance in preventing complications than IMN (OR = 0.31, 95% CrIs = 0.11–0.84); no other significant difference were observed. According to the SUCRA results, MIPO had a high-ranking probability in almost all outcomes, while external fixation had lowest values in the majority of outcomes.

Conclusions

We recommended MIPO as the optimal treatment for humeral shaft fractures after taking all outcomes into consideration; IMN was also recommended for its relatively good performance, but its complication still needed to be noticed.

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Acknowledgements

We would like to acknowledge the reviewers for their helpful comments on this paper. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Bone and Soft Tumor, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, No. 127 Dongming Road, Jinshui District, Zhengzhou, Henan, 450008, China

    Y. Zhao, J. Wang, W. Yao, Q. Cai & S. Gao

  2. Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450000, China

    Y. Wang

  3. Department of Joint Surgery, Central Hospital of Zhoukou City, Zhoukou, Henan, 466000, China

    W. Yuan

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  1. Y. Zhao
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  2. J. Wang
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  3. W. Yao
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  4. Q. Cai
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  5. Y. Wang
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  6. W. Yuan
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  7. S. Gao
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Corresponding author

Correspondence to S. Gao.

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Electronic supplementary material

Fig. S1

Net heat plot. The size of the gray squares indicates the contribution of the direct evidence (shown in the column) to the network evidence (shown in the row). The colors are associated with the change in inconsistency between direct and indirect evidence (shown in the row) after detaching the effect of each component meta-analysis (shown in the column). Blue colors indicate an increase of inconsistency and warm colors indicate a decrease (the stronger the intensity of the color, the stronger the change) (JPEG 1325 kb)

Fig. S2

Publication bias (JPEG 1603 kb)

Table S1

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Table S2

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Table S3

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Zhao, Y., Wang, J., Yao, W. et al. Interventions for humeral shaft fractures: mixed treatment comparisons of clinical trials. Osteoporos Int 28, 3229–3237 (2017). https://doi.org/10.1007/s00198-017-4174-1

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  • DOI: https://doi.org/10.1007/s00198-017-4174-1

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