The optimal choice for length unstable femoral shaft fracture in school-aged children

Li, Jin; Rai, Saroj; Ze, Renhao; Tang, Xin; Liu, Ruikang; Hong, Pan

doi:10.1097/md.0000000000020796

Cited by 12 publications

(39 citation statements)

References 27 publications

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“…Five articles included 300 cases provided data regarding length of hospital stay. [12,15,17,19,20] No difference was found in our study (MD = −0.50;95% CI = −1.62 to 0.63, P = .39) (Fig. 3D).…”

Section: Hospital Staycontrasting

confidence: 60%

“…Data were extracted from 4 studies to evaluate the operation time. [15,17,19,20] The difference was statistically significant between ESIN and SMP groups (MD = −16.16; 95% CI = −22.83 to −9.48, P < .00001) (Fig. 3A).…”

Section: Resultsmentioning

confidence: 93%

“…The outcome measure of blood loss during the operation was available in 4 studies. [15,17,19,20] The meta-analysis showed a significant difference between the ESIN and SMP groups (MD = −53.62; 95% CI = −58.89 to −48.36, P < .00001) (Fig. 3B).…”

Section: Resultsmentioning

confidence: 97%

“…The remaining 8 articles involving 561 patients met the inclusion criteria and were included in this review. [8,12,[15][16][17][18][19][20] Figure 1 shows the results flow chart for the whole search process.…”

Section: Study Identification and Selectionmentioning

confidence: 99%

“…The overall complication was reported in 7 studies. [8,12,[16][17][18][19][20] The meta-analysis revealed a significant difference between the ESIN and SMP groups (OR = 4.14; 95% CI = 2.51 to 6.84, P < .0001) (Fig. 5).…”

Section: Clinical Complicationmentioning

confidence: 99%

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Elastic stable intramedullary nail fixation versus submuscular plate fixation of pediatric femur shaft fractures in school age patients: A PRISMA-compliant systematic review and meta-analysis

Hu,

Xu,

Shi

et al. 2023

Medicine

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Background: Studies of clinical outcomes that compare the elastic stable intramedullary nail (ESIN) with the submuscular plate (SMP) were controversial. The meta-analysis was performed to summarize existing evidence, aiming to determine whether ESIN was superior to SMP in pediatric femur shaft fractures. Methods: Search strategies followed the recommendations of the Cochrane collaboration. Electronic searches such as PubMed, Embase, Web of Science, Cochrane were systematically searched for publications concerning ESIN and SMP from the inception date to March 2023. Two investigators independently searched, screened, and reviewed the full text of the article. Disagreements generated throughout the process were resolved by consensus, and if divergences remain, they were arbitrated by a third author. Results: This study included 8 articles, comprising a total of 561 patients with a similar baseline. Compared to the SMP, the ESIN had shorter operation time (mean difference = −16.16; 95% CI = −22.83 to −9.48, P < .00001), and less intraoperative blood loss (mean difference = −53.62; 95% CI = −58.89 to −48.36, P < .00001), but had a higher incidence of implant irritation (odds ratio [OR] = 6.49; 95% CI = 3.01 to 13.98, P < .0001), lower limb malalignment (OR = 2.60; 95% CI = 1.12 to 6.04, P = .96) and overall complications(OR = 4.14; 95% CI = 2.51 to 6.84, P < .0001). And there was no significant difference in radiation time, length of hospital stay, limb length discrepancy, infection rate, delayed union rate and unplanned revised surgery rate (P > .05). Conclusions: Compared to the SMP, the ESIN offers shorter operative time, and less blood loss. However, the SMP is superior to ESINs in complication rates, especially regarding implant irritation and malalignment. Both methods could achieve excellent satisfactory functional outcomes. Thus, the SMP is an alternative choice in the pediatric femur shaft fracture.

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Section: Hospital Staycontrasting

confidence: 60%

Section: Resultsmentioning

confidence: 93%

Section: Resultsmentioning

confidence: 97%

Section: Study Identification and Selectionmentioning

confidence: 99%

Section: Clinical Complicationmentioning

confidence: 99%

See 3 more Smart Citations

Elastic stable intramedullary nail fixation versus submuscular plate fixation of pediatric femur shaft fractures in school age patients: A PRISMA-compliant systematic review and meta-analysis

Hu,

Xu,

Shi

et al. 2023

Medicine

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Elastic Stable Intramedullary Nailing Versus Plate Internal Fixation for Pediatric Diaphyseal Femur Fractures: A Systematic Review and Meta-analysis

Liu,

Li,

Bai

et al. 2024

JOIO

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Background Elastic stable intramedullary nailing (ESIN) and plates are currently the main internal fixation for treating Pediatric Diaphyseal Femur Fractures (PDFF), and the optimal choice of internal fixation is controversial. The purpose of this meta-analysis is to compare the surgical outcomes and complications of the two fixation methods. Materials and Methods MEDLINE, Embase, and the Cochrane Library were systematically searched for studies published up to March, 2023, that compared ESIN and plate fixation techniques for treating PDFF. Pooled analysis identified differences in surgical outcomes between ESIN and plate, mainly regarding surgical outcomes and postoperative complications, such as time at surgery, fracture healing time, blood loss and related complications. Results We included 10 studies with 775 patients with PDFF in our review. Of these, 428 and 347 were treated with ESIN and Plate, respectively. In terms of postoperative complications, ESIN led to a shorter surgery time [MD = − 28.93, 95% CI (− 52.88 to − 4.98), P < 0.05], less blood loss [MD = − 66.94, 95% CI (− 87.79 to − 46.10), P < 0.001] and more fracture healing time [MD = 2.65, 95% CI (1.22–4.07), P < 0.001]. In terms of postoperative complications, ESIN led to fewer fections (RR = 0.77, 95% CI 0.37, 1.60, P = 0.48), fewer angulation deformities (RR = 0.80, 95% CI 0.35, 1.83, P = 0.60) and more prominent implants (RR = 3.36, 95% CI 1.88, 6.01, P < 0.001), more delayed unions (RR = 4.06, 95% CI 0.71, 23.06, P = 0.11). Conclusions ESIN and Plate have similar rates of complications besides a prominent implant rate, while ESIN has a shorter period of operation and less intraoperative bleeding. Although both options are suitable, the results of this study support the use of ESIN rather than plates in the treatment of PDFF in terms of complication rates. In clinical applications, surgeons should choose the appropriate treatment method according to the actual situation.

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Risk of complications following surgical fixation of femoral diaphyseal fractures in children aged 4 to 12 years: A systematic review and meta-analysis

Edwards

Daly

Donovan

et al. 2022

Injury

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The optimal choice for length unstable femoral shaft fracture in school-aged children

Cited by 12 publications

References 27 publications

Elastic stable intramedullary nail fixation versus submuscular plate fixation of pediatric femur shaft fractures in school age patients: A PRISMA-compliant systematic review and meta-analysis

Elastic stable intramedullary nail fixation versus submuscular plate fixation of pediatric femur shaft fractures in school age patients: A PRISMA-compliant systematic review and meta-analysis

Elastic Stable Intramedullary Nailing Versus Plate Internal Fixation for Pediatric Diaphyseal Femur Fractures: A Systematic Review and Meta-analysis

Risk of complications following surgical fixation of femoral diaphyseal fractures in children aged 4 to 12 years: A systematic review and meta-analysis

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