Comparing MIPO vs ORIF with plates or intramedullary nailing for humeral shaft fracture

Study Type: Meta-analysis/Systematic Review
OE Level of Evidence: 2
Journal Level of Evidence: N/A
Eight randomized controlled trials were included in this meta-analysis comparing minimally invasive plate osteosynthesis (MIPO) and open reduction and internal fixation (ORIF) with plates or intramedullary nails in the treatment of mid-shaft or distal-third diaphyseal humerus fractures. Results demonstrated significant differences between methods in operative time, functional outcome, and incidence of nerve injury, all in favour of MIPO fixation. No significant differences Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Non-funded
Conflicts: None disclosed
Why was this study needed now?
Humeral shaft fractures are a common traumatic injury, with some cases requiring surgical fixation. Open reduction and internal fixation, with either plates or intramedullary nails, is a traditional method of fixation. However, potential drawbacks have been noted with these forms of fixation. Several research trials have been conducted to investigating the efficacy of an alternative method of surgical fixation, the minimally invasive plate osteosynthesis (MIPO) technique. A meta-analysis of data from the high-quality trials evaluating the MIPO technique was needed to provide an estimate of it comparative efficacy with open reduction and internal fixation.
What was the principal research question?
Is there any significant difference in clinical outcome and complication rate between minimally invasive plate osteosynthesis (MIPO) and standard open fixation techniques, either open reduction and internal fixation (ORIF) with plating or intramedullary nailing, for the treatment of humeral shaft fractures?
Data Source: Medline, Embase, Scopus, and Google Scholar were searched for relevant articles.
Index Terms: Search strategy included: ("anterior" AND "humeral" AND "plating"), ("percutaneous" AND "humeral" AND "plating"), ("minimally invasive" AND "humeral" AND "plating"), ("anterior" AND "plating" AND "humeral") and ("fractures").
Study Selection: Eligibility criteria included: a randomized controlled trial (RCT) design; enrolled patients, 18 years of age or older, with either mid-shaft or distal-third diaphyseal humerus fractures; compared treatment between plate osteosynthesis via a percutaneous anterior approach (minimally invasive plate osteosynthesis [MIPO]) and traditional open reduction and internal fixation (ORIF) with plating , or between MIPO and intramedullary nailing; and reported time to union and a minimum of one patient-reported functional outcome measure. The selection was performed independently by two reviewers, with disagreement resolved by discussion and consensus. A total of 8 RCTs, with data sampled from 376 patients, were selected for final inclusion.
Data Extraction: Data extraction was performed by a single reviewer and cross-checked for accuracy by a second reviewer.
Data Synthesis: Statistical analysis was performed using Stata SE software. Heterogeneity was assessed using the Chi-square test and the I-squared (I^2) statistic.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.