Intramedullary versus extramedullary fixation in the management of subtrochanteric femur fractures: a meta-analysis
Pengcheng Liu,1,2,* Xing Wu,1,* Hui Shi,1,2 Run Liu,1 Hexi Shu,1 JinPeng Gong,1 Yong Yang,1 Qi Sun,1 Jiezhou Wu,1,2 Xiaoyang Nie,1 Ming Cai1 1Department of Orthopedics, Shanghai Tenth People’s Hospital, Tongji University, School of Medicine, Shanghai, 2First Clinical Medical College, Nanj...
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Dove Medical Press
2015
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oai:doaj.org-article:4de10a68bb9e473996800380a5bec40e2021-12-02T00:07:13ZIntramedullary versus extramedullary fixation in the management of subtrochanteric femur fractures: a meta-analysis1178-1998https://doaj.org/article/4de10a68bb9e473996800380a5bec40e2015-04-01T00:00:00Zhttps://www.dovepress.com/intramedullary-versus-extramedullary-fixation-in-the-management-of-sub-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Pengcheng Liu,1,2,* Xing Wu,1,* Hui Shi,1,2 Run Liu,1 Hexi Shu,1 JinPeng Gong,1 Yong Yang,1 Qi Sun,1 Jiezhou Wu,1,2 Xiaoyang Nie,1 Ming Cai1 1Department of Orthopedics, Shanghai Tenth People’s Hospital, Tongji University, School of Medicine, Shanghai, 2First Clinical Medical College, Nanjing Medical University, Nanjing, People’s Republic of China *These authors contributed equally to this work 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. Keywords: subtrochanteric femur fracture, extramedullary, intramedullary, systematic review, meta-analysis Liu PCWu XShi HLiu RShu HXGong JPYang YSun QWu JZNie XYCai MDove Medical Pressarticlesubtrochanteric femur fractureextramedullaryintramedullarysystematic reviewmeta-analysisGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 10, Pp 803-811 (2015) |
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subtrochanteric femur fracture extramedullary intramedullary systematic review meta-analysis Geriatrics RC952-954.6 |
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subtrochanteric femur fracture extramedullary intramedullary systematic review meta-analysis Geriatrics RC952-954.6 Liu PC Wu X Shi H Liu R Shu HX Gong JP Yang Y Sun Q Wu JZ Nie XY Cai M Intramedullary versus extramedullary fixation in the management of subtrochanteric femur fractures: a meta-analysis |
| description |
Pengcheng Liu,1,2,* Xing Wu,1,* Hui Shi,1,2 Run Liu,1 Hexi Shu,1 JinPeng Gong,1 Yong Yang,1 Qi Sun,1 Jiezhou Wu,1,2 Xiaoyang Nie,1 Ming Cai1 1Department of Orthopedics, Shanghai Tenth People’s Hospital, Tongji University, School of Medicine, Shanghai, 2First Clinical Medical College, Nanjing Medical University, Nanjing, People’s Republic of China *These authors contributed equally to this work 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. Keywords: subtrochanteric femur fracture, extramedullary, intramedullary, systematic review, meta-analysis |
| format |
article |
| author |
Liu PC Wu X Shi H Liu R Shu HX Gong JP Yang Y Sun Q Wu JZ Nie XY Cai M |
| author_facet |
Liu PC Wu X Shi H Liu R Shu HX Gong JP Yang Y Sun Q Wu JZ Nie XY Cai M |
| author_sort |
Liu PC |
| title |
Intramedullary versus extramedullary fixation in the management of subtrochanteric femur fractures: a meta-analysis |
| title_short |
Intramedullary versus extramedullary fixation in the management of subtrochanteric femur fractures: a meta-analysis |
| title_full |
Intramedullary versus extramedullary fixation in the management of subtrochanteric femur fractures: a meta-analysis |
| title_fullStr |
Intramedullary versus extramedullary fixation in the management of subtrochanteric femur fractures: a meta-analysis |
| title_full_unstemmed |
Intramedullary versus extramedullary fixation in the management of subtrochanteric femur fractures: a meta-analysis |
| title_sort |
intramedullary versus extramedullary fixation in the management of subtrochanteric femur fractures: a meta-analysis |
| publisher |
Dove Medical Press |
| publishDate |
2015 |
| url |
https://doaj.org/article/4de10a68bb9e473996800380a5bec40e |
| work_keys_str_mv |
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1718403925674033152 |