SynthesisBMC surgery2026
Iatrogenic complications in the removal of humeral intramedullary nails: a systematic review.
Synthesis in BMC surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
6 authors.
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Abstract
backgroundIntramedullary nailing is a widely recognized technique for the fixation of proximal and diaphyseal humeral fractures. While implant removal is sometimes performed to alleviate symptoms such as impingement or pain, the procedure is not devoid of risks. The aim of this study was to systematically review removal rates after anterograde humeral intramedullary nailing and to assess how removal-specific morbidity is reported, including the frequency and type of explicitly reported adverse events.
methodsThis systematic review was conducted in accordance with the PRISMA guidelines. We included studies involving adult patients that reported data on implant removal rates, reasons for removal, and associated complications. The MINORS score was used to assess study quality.
resultsA total of 13 studies were included, comprising 545 humeral nailing procedures. Removal rates varied significantly between studies, ranging from 1.8% in modern straight nail series to 38.9% in older curved nail series. The most frequently cited reasons for removal were proximal screw back-out, subacromial impingement, and nonunion. Removal-specific adverse events were explicitly reported in 3/13 studies; within these studies, 3 major events occurred among 12 removals. Across all removals (n = 75), at least 3 major events were confirmed (minimum rate: 4%, 3/75); this figure represents a lower bound, not an estimate, because 10/13 studies did not report removal-specific morbidity. The true incidence of removal-specific morbidity remains unknown, as only three of the thirteen included studies explicitly reported removal-related complications as a predefined study endpoint.
conclusionEvidence is limited and heterogeneous across implant generations and fracture patterns; estimates should be interpreted cautiously. The removal of humeral intramedullary nails is associated with iatrogenic risks, difficult extraction, and retained hardware. Routine removal is not supported by the current evidence base; decisions should be individualized to clear indications. PROSPERO REGISTRATION: CRD420251265725.
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