FLEXIBLE INTRAMEDULLARY NAILS IN PEDIATRIC SUBTROCHANTERIC FEMUR FRACTURE: BIOMECHANICAL STUDY.

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Abstract

Conflict of interest statement: All authors declare no potential conflict of interest related to this article. 10. Clin Interv Aging. 2015 Apr 28;10:803-11. doi: 10.2147/CIA.S82119. eCollection 2015. Intramedullary versus extramedullary fixation in the management of subtrochanteric femur fractures: a meta-analysis. Liu P(1), Wu X(2), Shi H(1), Liu R(2), Shu H(2), Gong J(2), Yang Y(2), Sun Q(2), Wu J(1), Nie X(2), Cai M(2). Author information: (1)Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, People's Republic of China ; First Clinical Medical College, Nanjing Medical University, Nanjing, People's Republic of China. (2)Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, People's Republic of China. BACKGROUND: Intramedullary and extramedullary fixation methods are used in the management of subtrochanteric femur fractures. However, whether intramedullary or extramedullary fixation is the primary treatment for subtrochanteric femur fractures in adults remains debatable. LEVEL OF EVIDENCE: Meta-analyses of prospective studies, level I. MATERIALS AND METHODS: The Cochrane library, Embase, Google Scholar, and PubMed databases were searched separately for all relevant studies published before January 1, 2015. No language restriction was applied. Prospective randomized controlled trials that compared intramedullary or extramedullary internal fixation to repair subtrochanteric femur fractures in adults were included. We determined intraoperative data, postoperative complications, fracture fixation complications, wound infection, hospital stay days, and final outcome measures to assess the relative effects of different internal fixation methods for the treatment of subtrochanteric femur fractures in adults. RESULTS: Six studies were included in our meta-analysis. The relative risks (RRs) of revision rate was 83% lower (RR, 0.17, 95% confidence interval [CI], 0.05 to 0.60; P=0.006), fixation failure rate was 64% lower (RR, 0.36, 95% CI, 0.12 to 1.08; P=0.07), non-union rate was 77% lower (RR, 0.23, 95% CI, 0.07 to 0.81; P=0.02) in the intramedullary group compared with the extramedullary group. No significant differences were found between the intramedullary group and extramedullary group for intraoperative data, postoperative complications, wound infection, hospital stay days or final outcome measures. CONCLUSION: In conclusion, our meta-analysis suggests that there was no significant difference in intraoperative data, postoperative complications, wound infection, hospital stay days or final outcome measures between intramedullary and extramedullary internal fixation. However, a significant decrease occurred in the rate of fracture fixation complications for patients treated with intramedullary internal fixation, especially in elderly patients. Some differences were not significant, but the treatment of elderly subtrochanteric femur fractures using intramedullary internal fixation is recommended. DOI: 10.2147/CIA.S82119 PMCID: PMC4423507