Comparing Augmentative Plating and Exchange Nailing for the Treatment of Nonunion of Femoral Shaft Fracture after Intramedullary Nailing: A Meta‐analysis

Abstract

Objective The aim of this meta‐analysis was to systematically evaluate the efficacy of augmentative plating (AP) and exchange nailing (EN) in the treatment of nonunion of femoral shaft fracture. Methods For the present meta‐analysis, PubMed, EMBASE, and the Cochrane Library were searched to identify relevant articles up to April 2019. Two investigators independently evaluated the quality of original publications following the guidelines proposed by the Cochrane Handbook. Data were extracted from the studies and analyzed using Review Manager 5.3. Results Five studies were included in this meta‐analysis, with a total of 506 patients. There were 232 patients in the AP group and 276 patients in the EN group. The AP group was associated with higher union rate (OR, 11.66; 95% CI, 4.31–31.50; P < 0.01), shorter union time (SMD, −1.10; 95% CI, −2.09 to −0.11; P = 0.03), shorter operation time (SMD, −0.55; 95% CI, −0.88 to −0.21; P < 0.01), less blood loss (SMD, −1.72; 95% CI, −3.33 to −0.11; P < 0.01), and fewer complications (OR, −0.11; 95% CI, −0.16 to −0.07; P < 0.01) than the EN group. Conclusion The results of the meta‐analysis showed that AP is found to be superior for nonunion of femoral shaft fractures in both intraoperatively (ie, shorter operation time and less blood loss) and postoperatively (ie, higher union rate, shorter union time, and lower complication rate). Overall, AP was superior to EN in the treatment of nonunion of femoral shaft fractures after intramedullary nailing (IMN).

Osteoperiosteal decortication and bone grafting combined with wave plating for femoral shaft aseptic atrophic nonunion after intramedullary nailing

“…A recent meta-analysis demonstrated that the femoral shaft nonunion healing rate was 98.7% (225/228) in the plate augmentation group and 78.9% (202/256) in the exchange nailing group, with respective mean union times of 9.0 months and 10.9 months. 20…”

“…However, a meta-analysis of five randomized controlled trials (256 patients) indicated a union rate of 78.9%. 20 Plate fixation is also a preferred treatment method. The success rate of plate augmentation with bone grafting in the treatment of nonunion is reportedly 100%.…”

“…A recent metaanalysis demonstrated that the femoral shaft nonunion healing rate was 98.7% (225/228) in the plate augmentation group and 78.9% (202/256) in the exchange nailing group, with respective mean union times of 9.0 months and 10.9 months. 20 Although Judet and Patel 9 were the first to report that osteoperiosteal decortication was an effective and simple technique for managing femoral shaft nonunion, this claim was based on cases treated after plate fixation. There were no clinical studies of osteoperiosteal decortication that developed nonunion following IMN of femoral shaft fractures.…”

“…The mean time to union (5.7 months) was lower than that in other reports. 17,20,24 The results were evaluated using the Paley bone and functional scores. The functional results were excellent in 19 cases and good in three.…”

Spatial Bridge Locking Fixator versus Traditional Locking Plates in Treating AO/OTA 32‐A3.2 Fracture: Finite Element Analysis and Biomechanical Evaluation

“…Moreover, the amount and direction of the IFM is not easy to control 2,17,18 . In addition, the nonunion rate was 10% 19 , and the complication rate was 20.5% 20 . Most importantly, implants that can accurately provide the optimal elasticity for the healing of simple fractures will become mainstream in the future.…”