Dynamic compression plating versus locked intramedullary nailing for humeral shaft fractures: a meta-analysis of RCTs and nonrandomized studies

J Orthop Sci. 2014 Mar;19(2):282-291. doi: 10.1007/s00776-013-0497-8. Epub 2013 Nov 19.


Purpose: There is no consensus regarding treatment of humeral shaft fracture. In this meta-analysis, we pooled studies to compare dynamic compression plate with locked intramedullary nail for this injury.

Methods: PubMed, MEDLINE, and Embase databases were searched for relevant studies published between January 1995 and July 2012. Evaluated endpoints were method-related complications and revision. Study quality was assessed, and meta-analyses were analyzed using the Cochrane Collaboration's REVMAN 5.0 software.

Results: Fourteen randomized controlled (RCTs) and nonrandomized studies with 727 patients were analyzed. There was a significantly higher risk of total method-related complications and shoulder impairment resulting from locked intramedullary nailing compared with dynamic compression plating. Plating was significantly associated with a higher risk of infection and postoperative nerve palsy. There was no significant difference with respect to nonunion and revision rate.

Conclusions: Nailing may cause more method-related complications and shoulder impartment than plating, although it may lead to a lower risk of infection and postoperative nerve palsy. In the future, more high-quality RCTs are required to enhance these conclusions.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Bone Plates*
  • Clinical Trials as Topic*
  • Fracture Fixation, Internal / instrumentation
  • Fracture Fixation, Intramedullary / methods*
  • Humans
  • Humeral Fractures / surgery*
  • Pressure
  • Randomized Controlled Trials as Topic
  • Treatment Outcome