Comparison of Clinical Outcomes Between Cephalomedullary Nails and Dynamic Hip Screws for Basicervical Proximal Femoral Fractures

Abstract

Background Basicervical proximal femoral fractures have greater biomechanical instability and higher incidence of implant-related complications than other types of proximal femoral fractures. The present retrospective study was performed to find a proper fixation treating basicervical proximal femoral fractures by a comparation of clinical outcomes between cephalomedullary nails and dynamic hip screws, and introduce our experience in surgical tricks and perioperative management. Methods Between January 2015 and December 2018, 821 patients aged 60 years or older suffering from a proximal femoral fracture and receive internal fixation surgery were reviewed. 25 patients of basicervical femoral fractures were included in the study according to inclusion and exclusion criteria. 7 patients were treated with a DHS, 18 with the CMN. Relevant operational data and clinical evaluation were collected. Results Reduction qualities of 6 patients were good (85.7%), 1 were acceptable (14.3%) in DHS Group and 14 of the 18 patients were good (77.8%), 4 were acceptable (22.2%) in CMN Group. The mean TAD in DHS Group of was 17.4 mm while 20.3 mm in CMN Group. Bone union had been achieved 19.9 weeks in DHS Group and 17.8 weeks in CMN Group. The mean Harris score at the final follow up was 83.9, 84.4 respectively in DHS and CMN Group with no significant difference. Conclusions DHS was not inferior for the treatment of basicervical proximal femoral fractures compared to CMNs with blade type or two integrated screw type. When applied properly, both CMNs with blade type or two integrated screw type and DHS can achieve satisfied prognosis. Our unique experiences included anatomic reduction during surgery, anti-osteoporosis treatment and prolonged weight-bearing time.

Cephalomedullary Nailing versus Dynamic Hip Screw Fixation in Basicervical Femoral Neck Fracture: A Systematic Review and Meta-Analysis

“…Data on fracture union time following the use of CMN and DHS fixation techniques were extracted from three studies. 7 21 24 The range of fracture union time was 13.5–24.0 weeks and 13.9–22.0 weeks in the CMN and DHS groups, respectively. The pooled analysis revealed that the DHS group required a longer time to achieve fracture union compared to the CMN group (MD: -0.41; 95% CI: -0.70 to -0.12; p =0.006).…”

“…Of the seven studies, 7 8 20 21 22 23 24 there were two randomized controlled trials (RCTs) 7 20 and the other five were retrospective cohort studies. 8 21 22 23 24…”

“…The mean follow-up period ranged from 1.0 year to 5.0 years. Two of the included studies 21 24 employed both simple radiographs and CT images to diagnose BFNFs, while the others used simple radiographs alone. Further details on each included study are presented in Table 1 .…”

“…With regard to the eight main evaluation parameters, five studies 21-25 received a point deduction for their retrospective design. All seven studies 7 8 20 21 22 23 24 received a point deduction for the lack of double-blind evaluation of subject endpoints. One study 20 received a point deduction for loss to follow-up of up to 5% compared to the initial number of enrolled patients.…”

“…One study 20 received a point deduction for loss to follow-up of up to 5% compared to the initial number of enrolled patients. All studies except one 7 8 21 22 23 24 received a point deduction in the study size calculation domain, as the sample size was not calculated prospectively in any of the studies. There were no point deductions in the other criteria domains.…”