A comparative study between gamma nail and percutaneous compression plating for the treatment of intertrochanteric hip fractures

Crespo, E.; Gálvez, Juan Francisco Pérez; Tenías, José María; Cano, Ignacio Andrés; Crespo, Rodrigo García; Palacios, V.

doi:10.1007/s00068-012-0181-2

Cited by 7 publications

(1 citation statement)

References 19 publications

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“…In addition, the cost of this implant has not been compared with the DHS. 33 The lack of information regarding the cost of PCCP may be indicative of high cost. Cost-effectiveness is extremely important and decisive factor in many treatments.…”

Section: Discussionmentioning

confidence: 99%

Is There Evidence that the Percutaneous Compression Plate Method of Internal Fixation for Intertrochanteric Hip Fractures Leads to Better Intraoperative and Postoperative Outcomes than the Dynamic Hip Screw?

Halle‐Smith

Carnegy

Carr

et al. 2018

Clinical Medicine Insights: Trauma and Intensive Medicine

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BACkgROunD: Hip fractures are common, expensive and lead to considerable morbidity and mortality. An ageing population in the United Kingdom means that rates of this injury are increasing, making them a pressing public health issue. The National Institute of Health and Care Excellence (NICE) recommends that extramedullary implants are used over intramedullary nails to fix intertrochanteric fractures, which make up half of all hip fractures. However, there is currently no guidance on the preferred type of extramedullary device whether this be the commonly used dynamic hip screw (DHS) or another newer device. It has been suggested that a percutaneous compression plate (PCCP) can reduce complications and improve functional outcome compared with the traditional DHS. REvIEw QuESTIOn: In patients with intertrochanteric hip fractures, is the PCCP more effective than the DHS in terms of relevant intraoperative and postoperative outcomes such as blood loss, implant failure, and mortality? LITERATuRE SEARCH: We first searched for relevant information in the NICE Clinical Guideline on Hip Fracture Management (CG124), then National Health Service (NHS) evidence for Clinical Knowledge Summaries, then the Cochrane library for systematic reviews. Finally, we conducted an electronic search of the PubMed database. REvIEw FInDIngS: We selected five systematic reviews and eight primary studies for review. The main findings were that the PCCP was associated with significantly less blood loss, fewer blood transfusions, and shorter operating times compared with the DHS. However, no significant differences were found in postoperative pain, orthopaedic performance, and mortality rates between the two methods. There was no comparison of cost-effectiveness between the two methods. COnCLuSIOnS: The PCCP is superior to the DHS in terms of intraoperative blood loss and, potentially, non-orthopaedic postoperative complications such as deep vein thrombosis and nosocomial infection. However, there was no significant difference in mortality rates between the two methods. Current studies on this topic have several methodological issues and some are of relatively poor quality. Further higher quality research and cost-effectiveness are necessary to further evaluate the efficacy of these methods.

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Section: Discussionmentioning

confidence: 99%

Is There Evidence that the Percutaneous Compression Plate Method of Internal Fixation for Intertrochanteric Hip Fractures Leads to Better Intraoperative and Postoperative Outcomes than the Dynamic Hip Screw?

Halle‐Smith

Carnegy

Carr

et al. 2018

Clinical Medicine Insights: Trauma and Intensive Medicine

View full text Add to dashboard Cite

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Extramedullary versus intramedullary fixation of stable trochanteric femoral fractures: a systematic review and meta-analysis

Zeelenberg¹,

Nugteren²,

Plaisier³

et al. 2023

Arch Orthop Trauma Surg

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Objective This systematic review and meta-analysis compared extramedullary fixation and intramedullary fixation for stable two-part trochanteric femoral fractures (AO type 31-A1) with regards to functional outcomes, complications, and surgical outcomes. Methods Embase, Medline, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar were searched for randomized controlled trials (RCTs) and observational studies. Effect estimates were pooled across studies using random effects models. Results were presented as weighted risk ratio (RR) or weighted mean difference (MD) with corresponding 95% confidence interval (95% CI). Results Five RCTs (397 patients) and 14 observational studies (21,396 patients) were included. No significant differences in functional outcomes, complications, or surgical outcomes were found between extramedullary and intramedullary fixation devices, except for a difference in duration of surgery (MD 14.1 min, CI 5.76–22.33, p < 0.001) and intra-operative blood loss (MD 92.30 mL, CI 13.49–171.12, p = 0.02), favoring intramedullary fixation. Conclusion Current literature shows no meaningful differences in complications, surgical, or functional outcomes between extramedullary and intramedullary fixation of stable two-part trochanteric femoral fractures. Both treatment options result in good outcomes. This study implicates that, costs should be taken into account when considering implants or comparing fixation methods in future research.

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Extramedullary versus intramedullary fixation of unstable trochanteric femoral fractures (AO type 31-A2): a systematic review and meta-analysis

Zeelenberg,

Plaisier,

Nugteren

et al. 2024

Arch Orthop Trauma Surg

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Objective The aim of this systematic review was to compare extramedullary fixation and intramedullary fixation for AO type 31-A2 trochanteric fractures in the elderly, with regard to functional outcomes, complications, surgical outcomes, and costs. Methods Embase, Medline, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar were searched for randomized controlled trials (RCTs) and observational studies. Effect estimates were pooled across studies using random effects models. Results are presented as weighted risk ratio (RR) or weighted mean difference (MD) with corresponding 95% confidence interval (95% CI). Results Fourteen RCTs (2039 patients) and 13 observational studies (22,123 patients) were included. Statistically superior results in favor of intramedullary fixation were found for Harris Hip Score (MD 4.09, 95% CI 0.91–7.26, p = 0.04), Parker mobility score (MD − 0.67 95% CI − 1.2 to − 0.17, p = 0.009), lower extremity measure (MD − 4.07 95% CI − 7.4 to − 0.8, p = 0.02), time to full weight bearing (MD 1.14 weeks CI 0.92–1.35, p < 0.001), superficial infection (RR 2.06, 95% CI 1.18–3.58, p = 0.01), nonunion (RR 3.67, 95% CI 1.03–13.10, p = 0.05), fixation failure (RR 2.26, 95% CI 1.16–4.44, p = 0.02), leg shortening (MD 2.23 mm, 95% CI 0.81–3.65, p = 0.002), time to radiological bone healing (MD 2.19 months, 95% CI 0.56–3.83, p = 0.009), surgery duration (MD 11.63 min, 95% CI 2.63–20.62, p = 0.01), operative blood loss (MD 134.5 mL, 95% CI 51–218, p = 0.002), and tip-apex distance > 25 mm (RR 1.73, 95% CI 1.10–2.74, p = 0.02). No comparable cost/costs-effectiveness data were available. Conclusion Current literature shows that several functional outcomes, complications, and surgical outcomes were statistically in favor of intramedullary fixation when compared with extramedullary fixation of AO/OTA 31-A2 fractures. However, as several of the differences found appear not to be clinically relevant and for many outcomes data remains sparse or heterogeneous, complete superiority of IM fixation for AO type 31-A2 fractures remains to be confirmed in a detailed cost-effectiveness analysis.

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A comparative study between gamma nail and percutaneous compression plating for the treatment of intertrochanteric hip fractures

Abstract: PCCP has lower overall economical cost and blood transfusional requirements for a similar or better outcome in terms of procedure-related complications.

Cited by 7 publications

References 19 publications

Is There Evidence that the Percutaneous Compression Plate Method of Internal Fixation for Intertrochanteric Hip Fractures Leads to Better Intraoperative and Postoperative Outcomes than the Dynamic Hip Screw?

Is There Evidence that the Percutaneous Compression Plate Method of Internal Fixation for Intertrochanteric Hip Fractures Leads to Better Intraoperative and Postoperative Outcomes than the Dynamic Hip Screw?

Extramedullary versus intramedullary fixation of stable trochanteric femoral fractures: a systematic review and meta-analysis

Extramedullary versus intramedullary fixation of unstable trochanteric femoral fractures (AO type 31-A2): a systematic review and meta-analysis

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