Non-unions and wound infections do not differ following intramedullary nailing and plate osteosynthesis for distal third femur fractures: a meta-analysis
Purpose: The fixation method of distal, extra-articular femur fractures is a controversially discussed. To ensure better stability itself, earlier mobilization and to prevent blood loss – all these are justifications for addressing the femur via reamed intramedullary nailing (RIMN). Anatomical repos...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Bioscientifica
2024-03-01
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| Series: | EFORT Open Reviews |
| Subjects: | |
| Online Access: | https://eor.bioscientifica.com/view/journals/eor/9/3/EOR-22-0140.xml |
| _version_ | 1797271948368019456 |
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| author | Andreas Frodl Johannes Hauss Andreas Fuchs Markus Siegel Hagen Schmal Jan Kühle |
| author_facet | Andreas Frodl Johannes Hauss Andreas Fuchs Markus Siegel Hagen Schmal Jan Kühle |
| author_sort | Andreas Frodl |
| collection | DOAJ |
| description | Purpose: The fixation method of distal, extra-articular femur fractures is a controversially discussed. To ensure better stability itself, earlier mobilization and to prevent blood loss – all these are justifications for addressing the femur via reamed intramedullary nailing (RIMN). Anatomical reposition of multifragmentary fractures followed by increased risks of non-union are compelling reasons against it. The purpose of this study was to systematically review the literature for rates of non-union and wound infection, as well as blood loss and time of surgery.
Methods: According to the PRISMA guidelines we conducted this systematic review by searching the Cochrane, PubMed, Ovid, MedLine, and Embase databases. Inclusion criteria were the modified Coleman methodology score (mCMS) >60, age >18 years, and extra-articular fractures of the distal femur. Biomechanical and animal studies were excluded. By referring to title and abstract relevant articles were reviewed independently. In the consecutive meta-analysis, we compared 9 studies and 639 patients.
Results: There is no statistically significant difference comparing superficial wound infections when RIMN was performed (OR = 0.50; 95% CI: 0.18 – 1.42; P = 0.19) as well as in deep wound infections (OR = 0.74; 95% CI: 0.19–2.81; P = 0.62). However, these results were not significant. We also calculated for potential differences in the rate of non-unions depending on the surgical treatment applied. Data of 556 patients revealed an overall number of 43 non-unions. There was no significant difference in rate of non-unions between both groups (OR = 0.97; 95% CI: 0.51–1.85; P = 0.92).
Conclusion: No statistical difference was found in our study among RIMN and plate fixation in the treatment of distal femoral fractures with regard to the incidence of non-union and wound infections. Therefore, the indication for RIMN or plating should be made individually and based on the surgeon’s experience. |
| first_indexed | 2024-03-07T14:17:32Z |
| format | Article |
| id | doaj.art-7c46aa0a48f6437d9385d6e067dc4749 |
| institution | Directory Open Access Journal |
| issn | 2058-5241 |
| language | English |
| last_indexed | 2024-03-07T14:17:32Z |
| publishDate | 2024-03-01 |
| publisher | Bioscientifica |
| record_format | Article |
| series | EFORT Open Reviews |
| spelling | doaj.art-7c46aa0a48f6437d9385d6e067dc47492024-03-06T11:26:22ZengBioscientificaEFORT Open Reviews2058-52412024-03-0193210216https://doi.org/10.1530/EOR-22-0140Non-unions and wound infections do not differ following intramedullary nailing and plate osteosynthesis for distal third femur fractures: a meta-analysisAndreas Frodl0Johannes Hauss1Andreas Fuchs2Markus Siegel3Hagen Schmal4Jan Kühle5Department of Orthopedics and Traumatology, Freiburg University Hospital, Freiburg, GermanyDepartment of Orthopedics and Traumatology, Freiburg University Hospital, Freiburg, GermanyDepartment of Orthopedics and Traumatology, Freiburg University Hospital, Freiburg, GermanyDepartment of Orthopedics and Traumatology, Freiburg University Hospital, Freiburg, GermanyDepartment of Orthopedic Surgery, University Hospital Odense, Odense, DenmarkDepartment of Orthopedics and Traumatology, Freiburg University Hospital, Freiburg, GermanyPurpose: The fixation method of distal, extra-articular femur fractures is a controversially discussed. To ensure better stability itself, earlier mobilization and to prevent blood loss – all these are justifications for addressing the femur via reamed intramedullary nailing (RIMN). Anatomical reposition of multifragmentary fractures followed by increased risks of non-union are compelling reasons against it. The purpose of this study was to systematically review the literature for rates of non-union and wound infection, as well as blood loss and time of surgery. Methods: According to the PRISMA guidelines we conducted this systematic review by searching the Cochrane, PubMed, Ovid, MedLine, and Embase databases. Inclusion criteria were the modified Coleman methodology score (mCMS) >60, age >18 years, and extra-articular fractures of the distal femur. Biomechanical and animal studies were excluded. By referring to title and abstract relevant articles were reviewed independently. In the consecutive meta-analysis, we compared 9 studies and 639 patients. Results: There is no statistically significant difference comparing superficial wound infections when RIMN was performed (OR = 0.50; 95% CI: 0.18 – 1.42; P = 0.19) as well as in deep wound infections (OR = 0.74; 95% CI: 0.19–2.81; P = 0.62). However, these results were not significant. We also calculated for potential differences in the rate of non-unions depending on the surgical treatment applied. Data of 556 patients revealed an overall number of 43 non-unions. There was no significant difference in rate of non-unions between both groups (OR = 0.97; 95% CI: 0.51–1.85; P = 0.92). Conclusion: No statistical difference was found in our study among RIMN and plate fixation in the treatment of distal femoral fractures with regard to the incidence of non-union and wound infections. Therefore, the indication for RIMN or plating should be made individually and based on the surgeon’s experience. https://eor.bioscientifica.com/view/journals/eor/9/3/EOR-22-0140.xmlfemoral fractureintramedullary nailingplate osteosynthesis |
| spellingShingle | Andreas Frodl Johannes Hauss Andreas Fuchs Markus Siegel Hagen Schmal Jan Kühle Non-unions and wound infections do not differ following intramedullary nailing and plate osteosynthesis for distal third femur fractures: a meta-analysis EFORT Open Reviews femoral fracture intramedullary nailing plate osteosynthesis |
| title | Non-unions and wound infections do not differ following intramedullary nailing and plate osteosynthesis for distal third femur fractures: a meta-analysis |
| title_full | Non-unions and wound infections do not differ following intramedullary nailing and plate osteosynthesis for distal third femur fractures: a meta-analysis |
| title_fullStr | Non-unions and wound infections do not differ following intramedullary nailing and plate osteosynthesis for distal third femur fractures: a meta-analysis |
| title_full_unstemmed | Non-unions and wound infections do not differ following intramedullary nailing and plate osteosynthesis for distal third femur fractures: a meta-analysis |
| title_short | Non-unions and wound infections do not differ following intramedullary nailing and plate osteosynthesis for distal third femur fractures: a meta-analysis |
| title_sort | non unions and wound infections do not differ following intramedullary nailing and plate osteosynthesis for distal third femur fractures a meta analysis |
| topic | femoral fracture intramedullary nailing plate osteosynthesis |
| url | https://eor.bioscientifica.com/view/journals/eor/9/3/EOR-22-0140.xml |
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