Published online Sep 18, 2022. doi: 10.5312/wjo.v13.i9.825
Peer-review started: October 26, 2021
First decision: February 15, 2022
Revised: February 28, 2022
Accepted: August 12, 2022
Article in press: August 12, 2022
Published online: September 18, 2022
Processing time: 325 Days and 10.9 Hours
Humeral shaft fractures are a common injury which could be managed non-operatively or operatively. There is a lack of clear evidence to support open reduction internal fixation vs intramedullary nail fixation.
Identify the fragility index, which identifies the number of patients have a change in outcome from a significant to non-significant. This is important as higher level studies guide management in orthopedics.
Applying the fragility index to humeral shaft fractures will aid in clinical decision making on treatment of humeral shaft fractures.
A systematic review of randomized controlled trials (RCTs) evaluating the surgical treatment of humeral shaft fractures was conducted. The fragility index (FI) was calculated for total complications, each complication individually, and secondary surgeries using the Fisher exact test, as previously published.
Fifteen RCTs were included in the analysis comparing open reduction plate osteosynthesis with dynamic compression plate or locking compression plate, intramedullary nail, and minimally invasive plate osteosynthesis. The median FI was 0 for all parameters analyzed. Regarding individual outcomes, the FI was 0 for 81/91 (89%) of outcomes. The FI exceeded the number lost to follow up in only 2/91 (2%) outcomes.
The FI shows that data from RCTs regarding operative treatment of humeral shaft fractures are fragile and does not demonstrate superiority of any particular surgical technique.
Further research is needed to delineate whether open reduction internal fixation or intramedullary nail fixation is superior in the management of humeral shaft fractures.