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Systematic Review

Intramedullary Nail vs. Plate Fixation for Pathological Humeral Shaft Fracture: An Updated Narrative Review and Meta-Analysis of Surgery-Related Factors

by
Bing-Kuan Chen
1,2,†,
Ting-Han Tai
1,3,†,
Shu-Hsuan Lin
1,3,
Kuan-Hao Chen
3,4,
Yu-Min Huang
3 and
Chih-Yu Chen
1,3,5,*
1
School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
2
Division of General Medicine, Department of Medical Education, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
3
Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
4
Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 11031, Taiwan
5
International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 11031, Taiwan
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
J. Clin. Med. 2024, 13(3), 755; https://doi.org/10.3390/jcm13030755
Submission received: 26 November 2023 / Revised: 22 January 2024 / Accepted: 25 January 2024 / Published: 28 January 2024
(This article belongs to the Special Issue Recent Advances in the Management of Pathological Fractures)
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Abstract

(1) Background: Pathological humeral shaft fracture (PHSF) is a frequently observed clinical manifestation in the later stages of tumor metastasis. Surgical interventions are typically recommended to alleviate pain and restore functionality. Intramedullary nail fixation (INF) or plate fixation (PF) is currently recommended for the treatment of PHSF. However, there is still no standard for optimal surgical treatment. Thus, we conducted a meta-analysis comparing the clinical outcomes of INF with PF for PHSF treatment. (2) Methods: We conducted searches in databases, such as Scopus, EMBASE, and PubMed, for studies published prior to May 2023. In total, nine studies with 485 patients were reviewed. (3) Results: There were no significant differences noted in the incidence of fixation failure, local recurrence, wound complication or overall complication. However, the INF group demonstrated a significantly lower incidence of postoperative radial nerve palsy than the PF group (OR, 5.246; 95% CI, 1.548–17.774; p = 0.008). A subgroup analysis indicated that there were no statistically significant differences in fixation failure or local recurrence among subgroups categorized by the design of intramedullary nail. (4) Conclusions: Considering the short life expectancy of end-stage patients, the choice of surgical method depends on the patient’s individual condition, fracture and lesion patterns, the surgeon’s experience, and comprehensive discussion between the surgeon and patient.
Keywords: plate; intramedullary nail; internal fixation; pathological humeral shaft fractures; bone metastasis; metastatic lesion; meta-analysis plate; intramedullary nail; internal fixation; pathological humeral shaft fractures; bone metastasis; metastatic lesion; meta-analysis

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MDPI and ACS Style

Chen, B.-K.; Tai, T.-H.; Lin, S.-H.; Chen, K.-H.; Huang, Y.-M.; Chen, C.-Y. Intramedullary Nail vs. Plate Fixation for Pathological Humeral Shaft Fracture: An Updated Narrative Review and Meta-Analysis of Surgery-Related Factors. J. Clin. Med. 2024, 13, 755. https://doi.org/10.3390/jcm13030755

AMA Style

Chen B-K, Tai T-H, Lin S-H, Chen K-H, Huang Y-M, Chen C-Y. Intramedullary Nail vs. Plate Fixation for Pathological Humeral Shaft Fracture: An Updated Narrative Review and Meta-Analysis of Surgery-Related Factors. Journal of Clinical Medicine. 2024; 13(3):755. https://doi.org/10.3390/jcm13030755

Chicago/Turabian Style

Chen, Bing-Kuan, Ting-Han Tai, Shu-Hsuan Lin, Kuan-Hao Chen, Yu-Min Huang, and Chih-Yu Chen. 2024. "Intramedullary Nail vs. Plate Fixation for Pathological Humeral Shaft Fracture: An Updated Narrative Review and Meta-Analysis of Surgery-Related Factors" Journal of Clinical Medicine 13, no. 3: 755. https://doi.org/10.3390/jcm13030755

APA Style

Chen, B.-K., Tai, T.-H., Lin, S.-H., Chen, K.-H., Huang, Y.-M., & Chen, C.-Y. (2024). Intramedullary Nail vs. Plate Fixation for Pathological Humeral Shaft Fracture: An Updated Narrative Review and Meta-Analysis of Surgery-Related Factors. Journal of Clinical Medicine, 13(3), 755. https://doi.org/10.3390/jcm13030755

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