No difference between lag screw and helical blade for cephalomedullary nail cut-out a systematic review and meta-analysis

Ng, Mitchell; Shah, Nihar S.; Golub, Ivan J; Ciminero, Matthew; Zhai, Kevin; Kang, Kevin; Piuzzi, Nicolás S.

doi:10.1007/s00590-021-03124-8

Cited by 14 publications

(15 citation statements)

References 44 publications

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“…The usefulness of other postoperative radiographic findings as prognostic factors for failed internal fixation and cut-out is debatable. TAD ≥ 25 is recognized as the predictive factor based on consensus [ 4 , 5 ]; however, we demonstrated that the prognostic value of TAD ≥ 25 was uncertain based on the serious risk of bias and inconsistency in the results from the included studies. Moreover, other postoperative radiographic findings had a serious risk of bias and concerns about publication bias or imprecision, which had not been sufficiently assessed in earlier reviews [ 4 , 5 ].…”

Section: Discussionmentioning

confidence: 91%

“…TAD ≥ 25 is recognized as the predictive factor based on consensus [ 4 , 5 ]; however, we demonstrated that the prognostic value of TAD ≥ 25 was uncertain based on the serious risk of bias and inconsistency in the results from the included studies. Moreover, other postoperative radiographic findings had a serious risk of bias and concerns about publication bias or imprecision, which had not been sufficiently assessed in earlier reviews [ 4 , 5 ]. Hence, routine assessment of these postoperative radiographic findings may be unnecessary because of lack of evidence.…”

Section: Discussionmentioning

confidence: 91%

“…Despite the limitations mentioned above, this is the first review to provide comprehensive evidence on the association between postoperative findings and failed internal fixation, which compensates for the scarcity of evidence in earlier systematic reviews [ 4 , 5 , 6 ]. Our findings are useful for establishing future clinical guidelines, intraoperative decision-making, postoperative follow-up management, and constructing clinical risk prediction models for failed internal fixation.…”

Section: Discussionmentioning

confidence: 99%

“…The exposures of interest were the following five immediate postoperative radiographic findings using plain radiography: Baumgaertner reduction criteria, overall alignment in the anteroposterior (AP) radiograph, local alignment on the anteromedial cortex, TAD, and screw placement in the femoral head. We selected these radiographic findings based on earlier reviews [ 4 , 5 , 6 ]. These were evaluated using AP and/or lateral plain radiography.…”

Section: Methodsmentioning

confidence: 99%

“…However, evidence on the prognostic value of postoperative radiographic findings for failed internal fixations is scarce. Some postoperative radiographic findings, such as the Baumgaertner reduction criteria and a high tip–apex distance (TAD), have been investigated for their association with failed internal fixation; however, no comprehensive summary is available [ 4 , 5 , 6 ]. Therefore, the factor that has the greatest impact on failed internal fixations remains undetermined.…”

Section: Introductionmentioning

confidence: 99%

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Association between Immediate Postoperative Radiographic Findings and Failed Internal Fixation for Trochanteric Fractures: Systematic Review and Meta-Analysis

Yamamoto

Tsujimoto

Yokoo

et al. 2022

JCM

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Failed internal fixations for trochanteric fractures have a strong negative impact owing to increased postoperative mortality and high medical costs. However, evidence on the prognostic value of postoperative radiographic findings for failed internal fixations is limited. We aimed to clarify the association between comprehensive immediate postoperative radiographic findings and failed internal fixation using relative and absolute risk measures. We followed the meta-analysis of observational studies in epidemiology guidelines and the Cochrane handbook. We searched specific databases in November 2021. The outcomes of interest were failed internal fixation and cut-out. We pooled the odds ratios and 95% confidence intervals using a random-effects model and calculated the number needed to harm for each outcome. Thirty-six studies involving 8938 patients were included. The certainty of evidence in the association between postoperative radiographic findings and failed internal fixation or cut-out was mainly low or very low except for the association between intramedullary malreduction on the anteromedial cortex and failed internal fixation. Moderate certainty of evidence supported that intramedullary malreduction on the anteromedial cortex was associated with failed internal fixation. Most postoperative radiographic findings on immediate postoperative radiographs for trochanteric fractures were uncertain as prognostic factors for failed internal fixations.

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