A meta-analysis comparing intramedullary with extramedullary fixations for unstable femoral intertrochanteric fractures

Sun, Dawei; Chen, Yuhui; Liu, Xiaochun; Zhao, Peng; Zhang, Hongan; Zhou, Hui; Qin, Chenghe

doi:10.1097/md.0000000000017010

Cited by 28 publications

(23 citation statements)

References 39 publications

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“…Few meta-analyses exist in literature comparing DHS alone to CMN for the management of these kinds of fractures [ 6 , 27 , 28 ]. However, most of the recent research demonstrated superior results of CMN to DHS alone when it comes to unstable trochanteric hip fractures management [ 6 , 8 , 27 – 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…Failure in cases managed by DHS alone is believed to be due to excessive lag screw sliding with collapse or medialisation of the distal fracture fragment even if the lag screw is optimally positioned in the femoral head [ 6 , 27 , 28 ]. The theoretical reasons behind that are thought to be either loss of the calcar support or lateral femoral wall insufficiency resulting in fracture collapse with loading [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…The choice of management of unstable trochanteric fractures includes cephalo-medullary nails (CMN), dynamic hip screw alone or with the addition of a trochanteric stabilisation plate (DHS w/ TSP), proximal femoral locked plate (PFLP) and angular blade plates (ABP) [ 5 ]. Cephalo-medullary nails have been acknowledged and validated by many studies as reliable fixation choices for unstable trochanteric fractures [ 6 – 8 ]. Accordingly, the use of CMN as the primary management option for fixation of unstable per-trochanteric fractures is widely accepted [ 6 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…Cephalo-medullary nails have been acknowledged and validated by many studies as reliable fixation choices for unstable trochanteric fractures [ 6 – 8 ]. Accordingly, the use of CMN as the primary management option for fixation of unstable per-trochanteric fractures is widely accepted [ 6 , 9 , 10 ]. Nonetheless, many studies have reported good functional and radiological outcomes in patients managed by DHS with the add-on TSP [ 5 , 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Cephalo-medullary nailing versus dynamic hip screw with trochanteric stabilisation plate for the treatment of unstable per-trochanteric hip fractures: a meta-analysis

et al. 2021

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Background The use of cephalo-medullary nails (CMN) is a widely accepted management option for the treatment of unstable per-trochanteric hip fractures. A growing body of literature has reported good functional and radiological outcomes in patients managed with a dynamic hip screw supplemented with a trochanteric stabilisation plate (DHS w/ TSP). However, a robust meta-analysis does not exist in the current literature comparing the two fixation methods. Purposes Management of these kinds of injuries is very challenging in orthopaedic practice, yet no strong evidence is in place to delineate which implant gives the best results. This meta-analysis is the first to determine the efficacy of CMN versus DHS w/ TSP. Methods An up-to-date literature search was performed using a predetermined search strategy and eligibility criteria. All suitable literature was appraised for methodological quality using the Cochrane’s collaboration tool. Hospital stay, operative time, intra-operative complication rate, mechanical failure rate, infection rates, revision rates and functional outcomes were all considered. Results A total of five studies were included in the meta-analysis. The results of this analysis suggest that CMN is only associated with lower revision rates when compared to DHS w/ TSP; however, no significant difference was found in terms of hospital stay, operative time, blood transfusion, complications rate and functional outcome. Conclusion Both CMN and DHS w/TSP proved to be reliable in the management of unstable per-trochanteric fractures; however, more extensive datasets are required to draw robust conclusions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cephalo-medullary nailing versus dynamic hip screw with trochanteric stabilisation plate for the treatment of unstable per-trochanteric hip fractures: a meta-analysis

et al. 2021

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“…The treatment for intertrochanteric fractures of the femur can be divided into conservative treatment and surgical treatment. Most doctors agree that conservative treatment of ITFs results in serious complications and sequelae, such as the need for bed rest and limb traction, and a mortality rate within 1 year after injury is relatively high. Surgical treatment achieves firm and stable internal fixation of the fracture and early functional training, and reduces complications due to long‐term bed rest.…”

Section: Introductionmentioning

confidence: 99%

Procedure for Femoral Intertrochanteric Fractures using the “Three‐Finger Method” Assisted by Proximal Femoral Nail Antirotation

Cheng

Lin

Zhu

et al. 2020

Orthopaedic Surgery

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Objective: To assess long-term follow-up evaluations for the treatment of femoral intertrochanteric fractures with the "three-finger method" assisted by proximal femoral nail antirotation (PFNA). , 123 patients were selected and followed for the treatment of femoral intertrochanteric fractures with PFNA assisted by the "three-finger method" (application of the index finger, middle finger, and ring finger in the process of surgery to assist PFNA). There were 56 male patients and 67 female patients aged 52-93 years with an average age of 75.6 years, and 88 cases were due to a fall and 35 due to a traffic accident injury. The femoral necks were fixed with PFNA assisted by the "three-finger method" applying the following procedure: traction reduction, determining the incision, inserting the needle, and placing screw. The Harris hip score, postoperative complications, hip pain and function status were statistically analyzed to evaluate the surgical efficacy and to discuss the surgical technique of the "three-finger method" assisted by PFNA.Results: According to the Harris scoring criteria, patients were followed for 1, 2, 4, 6, and 8 years, and the good outcomes of patients were recorded. The excellent and good rate of 87% was the highest in the second year of follow-up. Then, the rate decreased following the eighth year of follow-up. The excellent and good rate of 82.7% was the lowest. The patients with incisions healed well, there were no instances of fat liquefaction or infection. There were three cases of effusion, the rate was 2.4%. The secretions were cultured, and no bacterial growth was found. After treatment of the wound, it healed, and the spiral blade used for the femoral head did not wear out. There was one case of femoral head necrosis. There was no significant correlation between hip pain and sex and age (P > 0.05), and the function of the hip joint was significantly correlated with the age of the patients (P < 0.05). Conclusion:The "three-finger method" in the process of surgery to assist PFNA for the treatment of patients with intertrochanteric fractures of the femur simplified the operation steps, reduced the operation difficulty, shortened the operation time, improved the operation efficiency, and reduced the incidence of postoperative complications.

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Intramedullary Nailing vs Sliding Hip Screw in Trochanteric Fracture Management

et al. 2023

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ImportanceFractures of the hip have devastating effects on function and quality of life. Intramedullary nails (IMN) are the dominant implant choice for the treatment of trochanteric fractures of the hip. Higher costs of IMNs and inconclusive benefit in comparison with sliding hip screws (SHSs) convey the need for definitive evidence.ObjectiveTo compare 1-year outcomes of patients with trochanteric fractures treated with the IMN vs an SHS.Design, Setting, and ParticipantsThis randomized clinical trial was conducted at 25 international sites across 12 countries. Participants included ambulatory patients aged 18 years and older with low-energy trochanteric (AO Foundation and Orthopaedic Trauma Association [AO/OTA] type 31-A1 or 31-A2) fractures. Patient recruitment occurred between January 2012 and January 2016, and patients were followed up for 52 weeks (primary end point). Follow-up was completed in January 2017. The analysis was performed in July 2018 and confirmed in January 2022.InterventionsSurgical fixation with a Gamma3 IMN or an SHS.Main Outcomes and MeasuresThe primary outcome was health-related quality of life (HRQOL), measured by the EuroQol–5 Dimension (EQ5D) at 1-year postsurgery. Secondary outcomes included revision surgical procedure, fracture healing, adverse events, patient mobility (measured by the Parker mobility score), and hip function (measured by the Harris hip score).ResultsIn this randomized clinical trial, 850 patients were randomized (mean [range] age, 78.5 [18-102] years; 549 [64.6% female) with trochanteric fractures to undergo fixation with either the IMN (n = 423) or an SHS (n = 427). A total of 621 patients completed follow-up at 1 year postsurgery (304 treated with the IMN [71.9%], 317 treated with an SHS [74.2%]). There were no significant differences between groups in EQ5D scores (mean difference, 0.02 points; 95% CI, −0.03 to 0.07 points; P = .42). Furthermore, after adjusting for relevant covariables, there were no between-group differences in EQ5D scores (regression coefficient, 0.00; 95% CI, −0.04 to 0.05; P = .81). There were no between-group differences for any secondary outcomes. There were also no significant interactions for fracture stability (β [SE] , 0.01 [0.05]; P = .82) or previous fracture (β [SE], 0.01 [0.10]; P = .88) and treatment group.Conclusions and RelevanceThis randomized clinical trial found that IMNs for the treatment of trochanteric fractures had similar 1-year outcomes compared with SHSs. These results suggest that the SHS is an acceptable lower-cost alternative for trochanteric fractures of the hip.Trial RegistrationClinicalTrials.gov Identifier: NCT01380444

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A meta-analysis comparing intramedullary with extramedullary fixations for unstable femoral intertrochanteric fractures

Abstract: Supplemental Digital Content is available in the text

Cited by 28 publications

References 39 publications

Cephalo-medullary nailing versus dynamic hip screw with trochanteric stabilisation plate for the treatment of unstable per-trochanteric hip fractures: a meta-analysis

Cephalo-medullary nailing versus dynamic hip screw with trochanteric stabilisation plate for the treatment of unstable per-trochanteric hip fractures: a meta-analysis

Procedure for Femoral Intertrochanteric Fractures using the “Three‐Finger Method” Assisted by Proximal Femoral Nail Antirotation

Intramedullary Nailing vs Sliding Hip Screw in Trochanteric Fracture Management

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