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Higher rates of radial nerve injury
12%
556/4693
Higher total complication rate
72%
3364/4693
Lower rates of nonunion
7%
327/4693
Lower rates of shoulder impingement
3%
143/4693
Lower rates of malunion
6%
281/4693
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Antegrade intramedullary (IM) nailing of humeral shaft fractures has been found to be associated with increased complication rates when compared with open reduction and internal fixation (ORIF). Operative treatment of humeral shaft fractures remains controversial, with prospective randomized studies demonstrating small differences between IM nailing and ORIF. Heineman et al. (2010) conducted a meta-analysis of prospective randomized studies comparing IM nailing with ORIF for humeral shaft fractures. The authors found no significant difference between the two treatment modalities for either their primary outcome (complications) or any of the secondary outcomes (nonunion, infection, nerve palsy, re-operation) Heineman et al. (2012) have recently conducted an update on their meta-analysis to include more recent randomized studies. With the inclusion of these newer studies the author found a statistically significant increase in total complication rate with the use of IM nailing compared with ORIF. Figure A demonstrates a displaced, transverse humeral shaft fracture. Figure B demonstrates antegrade IM nailing of a humeral shaft fracture Incorrect Answers: Answer 1: Radial nerve injury has not been shown to be different between IM nailing and ORIF Answer 3: No difference in union rates between the two modalities in prospective studies Answer 4: Higher rates of shoulder impingement have been seen with IM nailing in some studies Answer 5: No difference in rates of malunion between IM nailing and ORIF
3.6
(24)
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