Is Minimally Invasive Plating Osteosynthesis Better Than Conventional Open Plating for Humeral Shaft Fractures? A Systematic Review and Meta-Analysis of Comparative Studies

Kumar Keshav; Anurag Baghel; Vishal Kumar; Deepak Neradi; Kumar Kaustubh; Prabhaker Mishra

doi:10.1007/s43465-021-00413-6

Is Minimally Invasive Plating Osteosynthesis Better Than Conventional Open Plating for Humeral Shaft Fractures? A Systematic Review and Meta-Analysis of Comparative Studies

Indian J Orthop. 2021 May 9;55(Suppl 2):283-303. doi: 10.1007/s43465-021-00413-6. eCollection 2021 Jul.

Authors

Kumar Keshav¹, Anurag Baghel¹, Vishal Kumar², Deepak Neradi², Kumar Kaustubh³, Prabhaker Mishra⁴

Affiliations

¹ Department of Orthopaedics, Apex Trauma Centre, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh 226029 India.
² Spine Surgery, Department of Orthopaedics, PGIMER, Chandigarh, 160012 India.
³ Lady Hardinge Medical College, New Delhi, 110001 India.
⁴ Department of Biostatistics and Health Informatics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh 226029 India.

Abstract

Introduction: The aim of systematic review and meta-analysis was to find out whether minimally invasive plate osteosynthesis (MIPO) is better than open reduction and internal plate fixation (ORIF) in terms of functional outcome, achieving union (union time and incidence of non-union), intraoperative parameters (surgical duration, blood loss, and radiation exposure), and complications (iatrogenic radial nerve palsy and infection) for humeral shaft fractures.

Materials and methods: We searched online databases (Pubmed, Embase, Scopus, and The Cochrane Library) from inception till 3rd September 2020 for articles comparing MIPO with ORIF for humeral shaft fractures. The methodological quality of randomized controlled trials (RCTs) was done by Cochrane Risk of Bias assessment tool 2 (RoB2) and of non-randomized studies (case-control and cohort studies) by Methodological Index for non-randomized studies (MINORS). Meta-analysis was performed using Review Manager 5.4 software.

Results: 11 studies (5 RCTs and 6 non-randomized comparative studies) involving a total of 582 patients (MIPO-290, ORIF-292) meeting our inclusion criteria were included in the study. There was no statistically significant difference in pooled analysis of functional outcome scores between MIPO and ORIF. Union time was significantly lesser (mean difference = 3.12 weeks) and incidence of non-union lower (odd's ratio = 0.27) in MIPO group. Surgical duration and intraoperative blood loss were significantly lesser in MIPO group. Iatrogenic radial nerve palsy and infection were higher in ORIF group.

Conclusions: This study showed that MIPO gives similar functional outcomes as compared to ORIF but causes significantly lesser blood loss, requires lesser operative duration and has a lesser incidence of major complications.

Trial registration: International prospective register of systematic reviews (PROSPERO)-CRD42020208346, Date of registration 09/10/2020.

Supplementary information: The online version contains supplementary material available at 10.1007/s43465-021-00413-6.

Keywords: Humeral diaphyseal fractures; Humeral shaft fractures; MIPO; Minimally invasive plate osteosynthesis; Minimally invasive surgical procedures; ORIF; ORPO; Open reduction and internal fixation; Open reduction and plate fixation.

Publication types

Review