2023 OTA Annual Meeting : Conservative Management With Functional Brace Versus Various Surgical Fixation Techniques for Humeral Shaft Fractures: A Network Meta-Analysis

21 randomized controlled trials including 1,203 humeral shaft fracture patients were included in this network meta-analysis comparing functional bracing to a range of surgical fixation techniques including open reduction and internal fixation (ORIF), minimally invasive plate osteosynthesis (MIPO), and intramedullary nailing through antegrade (aIMN) and retrograde (rIMN) approaches. The outcomes of interest included union-related outcomes, secondary surgical intervention, iatrogenic radial nerve palsy, and infection. Functional bracing had significantly higher rates of non-union and re-operation compared to the surgical techniques. MIPO had the best outcomes of the surgical fixation techniques, with the lowest rate of non-union and the fastest time to union. ORIF was associated with increased risk of iatrogenic radial nerve palsy and superficial infection compared to functional bracing and MIPO.