Case-Match Controlled Comparison of Minimally Invasive Plate Osteosynthesis and Intramedullary Nailing for the Stabilization of Humeral Shaft Fractures

Gareth Davies, Gerald Yeo, Mahendrakumar Meta, David Miller, Erik Hohmann, Kevin Tetsworth

To compare the risk of major complications after either minimally invasive plate osteosynthesis (MIPO) or intramedullary nailing (IMN) of humeral shaft fractures. Retrospective, case-match controlled study. A major metropolitan tertiary referral trauma center in Australia. Thirty patients with fractures of the humeral shaft. Either MIPO or IMN were performed on 15 patients each with traumatic humeral shaft fractures. The cumulative risk of 3 major complications associated with these procedures: nonunion, infection, and iatrogenic radial nerve injury. An overall major complication rate of 53% was observed in the patients treated with IMN; one complication (7%) was identified in those managed with humeral MIPO, a nonunion. Complications after IMN included 4 patients (27%) with nonunion, 3 patients (20%) with iatrogenic radial nerve injuries, and 1 patient (7%) with a wound infection. Statistical analysis revealed a significant between-group difference (P = 0.01) in the cumulative rate of major complications. When each of these complications was considered independently, no statistically significant difference was demonstrated. This study suggests that humeral MIPO results in a significantly lower pooled major complication rate than that of IMN, and it should therefore be considered an attractive alternative to IMN in those patients requiring surgical stabilization of a traumatic humeral shaft fracture. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.