Comparison of Outcomes of Long Versus Short Cephalomedullary Nails for the Fixation of Intertrochanteric Femur Fractures: A Systematic Review and Meta-analysis of 14,547 Patients

Rajnish, Rajesh Kumar; Srivastava, Amit; Kumar, Prasoon; Yadav, Sunil; Sharma, Siddhartha; Haq, Rehan Ul; Aggarwal, Aditya

doi:10.1007/s43465-023-00915-5

JOIO

2023

DOI: 10.1007/s43465-023-00915-5

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Comparison of Outcomes of Long Versus Short Cephalomedullary Nails for the Fixation of Intertrochanteric Femur Fractures: A Systematic Review and Meta-analysis of 14,547 Patients

Rajesh Kumar Rajnish

Amit Srivastava

Prasoon Kumar

et al.

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2024

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Cited by 3 publications

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“…Simulators exist for cannulated screws, Hansson pins, and sliding hip screw (SHS) [5][6][7]. However, a short antegrade nail is a frequent choice for osteosynthesis of extracapsular PFF in many countries [8], but no virtual reality simulator with force feedback for this procedure has been described.…”

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confidence: 99%

Setting proficiency standards for simulation-based mastery learning of short antegrade femoral nail osteosynthesis: a multicenter study

Gustafsson,

Rölfing,

Palm

et al. 2024

ActaO

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Background and purpose: Orthopedic trainees frequently perform short antegrade femoral nail osteosynthesis of trochanteric fractures, but virtual reality simulation-based training (SBT) with haptic feedback has been unavailable. We explored a novel simulator, with the aim of gathering validity evidence for an embedded test and setting a credible pass/fail standard allowing trainees to practice to proficiency.Patients and methods: The research, conducted from May to September 2020 across 3 Danish simulation centers, utilized the Swemac TraumaVision simulator for short antegrade femoral nail osteosynthesis. The validation process adhered to Messick’s framework, covering all 5 sources of validity evidence. Participants included novice groups, categorized by training to plateau (n = 14) or to mastery (n = 10), and experts (n = 9), focusing on their performance metrics and training duration.Results: The novices in the plateau group and experts had hands-on training for 77 (95% confidence interval [CI] 59–95) and 52 (CI 36–69) minutes while the plateau test score, defined as the average of the last 4 scores, was 75% (CI 65–86) and 96% (CI 94–98) respectively. The pass/fail standard was established at the average expert plateau test score of 96%. All novices in the mastery group could meet this standard and interestingly without increased hands-on training time (65 [CI 46–84] minutes).Conclusion: Our study provides supporting validity evidence from all sources of Messick’s framework for a simulation-based test in short antegrade nail osteosynthesis of intertrochanteric hip fracture and establishes a defensible pass/fail standard for mastery learning of SBT. Novices who practiced using mastery learning were able to reach the pre-defined pass/fail standard and outperformed novices without a set goal for external motivation.

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confidence: 99%

Setting proficiency standards for simulation-based mastery learning of short antegrade femoral nail osteosynthesis: a multicenter study

Gustafsson,

Rölfing,

Palm

et al. 2024

ActaO

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Initial construct stability of long cephalomedullary nails with superior locking for a complex trochanteric fracture model AO31A2.2– a biomechanical study

Schulz,

Münch,

Barth

et al. 2024

J Orthop Surg Res

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Background Complex fractures of the trochanteric region, as well as fractures located in the directly subtrochanteric region, are controversially discussed around the world regarding the nail type to be used. A long nail is recommended by manufacturers but requires longer surgical and fluoroscopy times. A possible solution could be a nail with an appropriate length which can be locked in a minimally invasive manner by the main aiming device. We aimed to determine if such a nail model (DCN SL nail, SWEMAC, Linköping, Sweden) offers similar structural stability on biomechanical testing on artificial bone as a standard long nail when used to treat complex trochanteric fractures and compared it to long nails usually used in this setting. Methods An osteoporotic bone model was chosen. The Swemac Hansson DCN Nail System was used as osteosynthesis material. Two types of nails were chosen: a superior lock nail which can be implanted with a singular targeting device, and a long nail with distal locking using free-hand technique. AO31A2.2 fractures were simulated in a standardised manner. Axial height of the construct, varus collapse, and rotational deformity directly after nail insertion were simulated. A Universal Testing Machine was used. Measurements were made with a stereo-optic tracking system. Findings There was a detectable difference in the axial fracture movement resulting in narrowing of the fracture gap. There was no difference in varus collapse or rotational deformity between the nail variants Conclusion We conclude that there are small differences which are clinically insignificant and that a superior locking nail can safely be used to manage complex trochanteric fractures. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-024-05079-y.

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Comparison of Short-Term Clinical Outcomes of the DePuy Synthes Femoral Reconstruction Nail with the Synthes Expert Retrograde/Antegrade Femoral Nail for Intramedullary Nailing in Femoral Shaft Fractures

Mehta,

Allen,

Slattery

et al. 2024

SurgiColl

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Objectives The objective of this study is to compare the complications, rates of reoperation, and related secondary measures between two devices used to manage femoral shaft fractures: the DePuy Synthes Femoral Recon Nail (FRN) and its predecessor, the DePuy Synthes Expert Retrograde/Antegrade Femoral Nail (R/AFN). The primary null hypothesis was that the two devices had no significant difference in the clinical outcomes. Our secondary hypothesis was that there is no significant difference in the duration of surgery between the two devices. Methods This study reviewed charts of all patients aged 18-89 who underwent antegrade intramedullary nailing for a femoral shaft fracture, subtrochanteric femur fracture, or a combined femoral neck/shaft fracture with either a FRN or a R/AFN from January 1st, 2010, to April 1st, 2022, at a single level 1 trauma center. A total of 88 subjects were identified for study inclusion: 30 patients who underwent fixation with the R/AFN system and 58 patients who received treatment with the FRN system. These subjects’ charts and radiographs were then analyzed for patient characteristics, fracture characteristics, radiographic outcomes, and clinical outcomes. Statistical significance between variables was ascertained using chi-squared analysis and t-tests. Significant results were confirmed via power analysis with a two-sample t-test and normalization for demographic differences using linear regression. Results Average body mass indexes (BMIs) were 24.6±4.4 kg/m2 and 27.9±4.6 kg/m2 for the R/AFN and FRN groups, respectively (P=.002). The duration of surgery was 2.4±1.0 hours for the R/AFN cohort and 3.1±1.1 hours for the FRN cohort (P=.01). No statistically significant differences were found in the clinical outcomes between the two devices. Conclusion The FRN has short-term clinical outcomes comparable to the R/AFN in terms of safety and efficacy.

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Comparison of Outcomes of Long Versus Short Cephalomedullary Nails for the Fixation of Intertrochanteric Femur Fractures: A Systematic Review and Meta-analysis of 14,547 Patients

Cited by 3 publications

References 63 publications

Setting proficiency standards for simulation-based mastery learning of short antegrade femoral nail osteosynthesis: a multicenter study

Setting proficiency standards for simulation-based mastery learning of short antegrade femoral nail osteosynthesis: a multicenter study

Initial construct stability of long cephalomedullary nails with superior locking for a complex trochanteric fracture model AO31A2.2– a biomechanical study

Comparison of Short-Term Clinical Outcomes of the DePuy Synthes Femoral Reconstruction Nail with the Synthes Expert Retrograde/Antegrade Femoral Nail for Intramedullary Nailing in Femoral Shaft Fractures

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