Nonunion and Postoperative Complications Associated With Intramedullary Nailing Versus Plate Fixation of Humeral Shaft Fractures.

BACKGROUND

Understanding the outcomes of humeral shaft fracture treatment using open reduction and internal fixation (ORIF) or intramedullary nailing (IMN) is essential for optimizing patient management strategies. The aim of this study was to identify the outcomes following plate fixation versus IMN in humeral shaft fractures.

METHODS

A retrospective cohort study was conducted using electronic medical records from January 2005 to March 2023. A propensity score match was performed based on demographic variables and comorbidities. The primary outcome measured was nonunion. Secondary outcomes included malunion, radial nerve palsy, surgical site infections, wound dehiscence, and revision surgery rates.

RESULTS

Following propensity matching, the study analyzed 6592 patients equally distributed between the ORIF and IMN cohorts. The risk of nonunion was significantly higher with ORIF versus IMN, {risk ratio (RR) = 1.70 (95% confidence interval [CI], 1.52-1.91; P < 0.001)}. Radial nerve palsy was more common with ORIF versus IMN (RR = 2.37 [95% CI, 2.22-2.53; P < 0.001]). Deep infections were more frequent with ORIF versus IMN (RR = 1.56 [95% CI, 1.38-1.78; P = 0.006]). No significant differences were observed for malunion (P = 0.742), total surgical site infections (P = 0.841), or revision surgery (P = 0.216). Wound dehiscence was greater in the ORIF group (RR = 1.54, [95% CI, 1.34-1.76; P = 0.014]).

CONCLUSION

The findings indicate that IMN is associated with a lower risk of nonunion and radial nerve palsy compared with ORIF with plate fixation in the treatment of humeral shaft fractures. These insights can guide clinicians in making informed decisions regarding surgical intervention, highlighting the importance of individualized treatment planning to mitigate complication risks.