Condylocephalic nails versus extramedullary implants for extracapsular hip fractures

Parker, Martyn J.; Handoll, Helen

doi:10.1002/14651858.cd000338

Cited by 29 publications

(20 citation statements)

References 21 publications

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“…Although several systematic reviews of treatment options for extra-capsular fractures have been published in the Cochrane Library (e.g. [24,25]), a critical comprehensive review of the unstable fracture sub-group was missing. Systematic reviews are essential tools to provide evidence related to a particular field and are more objective than traditional narrative reviews [6].…”

Section: Introductionmentioning

confidence: 99%

Implant-related complications in the treatment of unstable intertrochanteric fractures: meta-analysis of dynamic screw-plate versus dynamic screw-intramedullary nail devices

Audigé

Hanson

Swiontkowski

2003

International Orthopaedics

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The choice between dynamic screw-intramedullary nail (DSIN) devices and dynamic screw-plate (DSP) devices for the fixation of unstable trochanteric fractures remains controversial. This study presents a meta-analysis of fixation failures in unstable trochanteric femoral fractures using DSP devices or DSIN devices. Two independent assessors selected randomised controlled trials using a range of electronic databases, as well as reference lists of selected articles. A study quality checklist was used. The occurrence of fixation failure, in particular cut-out, was the primary subject of analysis using descriptive statistics and random-effect meta-analyses. Seventeen trials were identified. Meta-analyses showed no significant difference in the frequency of implant-related complications between the two types of devices. Iatrogenic femoral fractures associated with the use of DSIN devices represent a rare, but persistent, risk. There was a tendency for less frequent cut-out with intramedullary devices compared with DSP devices.Résumé Le choix entre clou centro-médullaire avec vis dynamique et vis-plaque dynamique pour la fixation des fractures trochantériennes instables reste controversé. Cette étude présente une méta-analyse d'échecs de la fixation des fractures trochantériennes instables utilisant ces deux procédés. Deux observateurs indépendants ont selectioné des études cliniques randomisées utilisant plusieurs bases de données électroniques, aussi bien que les listes de référence des articles sélectionnés. Une liste de contrôle de la qualité de l'étude a été utilisée. L'événe-ment d'échec de la fixation, en particulier la protrusion articulaire, était le sujet fondamental d'analyse. Dix-sept études cliniques randomisées ont été identifiées. La méta-analyse n'a montré aucune différence notable dans la fréquence des complications liées à l'implant entre les deux types de matériel. Les fractures fémorales iatrogène associées à l'usage de matériel centro-médullaire repré-sentent un risque rare, mais persistant. Il y avait une tendance à des protrusions articulaires moins fréquents avec le système intramédullaire comparé avec les vis-plaque dynamiques.

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Section: Introductionmentioning

confidence: 99%

Implant-related complications in the treatment of unstable intertrochanteric fractures: meta-analysis of dynamic screw-plate versus dynamic screw-intramedullary nail devices

Audigé

Hanson

Swiontkowski

2003

International Orthopaedics

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“…8 In 90% of cases of extramedullary fixation implants, the average operative time were 120-150 minutes and mean blood loss was 400-600 ml. Mean operative time for intramedullary devices was 90-120 minutes with average blood loss of 3000400 ml.…”

Section: Discussionmentioning

confidence: 97%

Comparison of efficacy of extramedullary fixation devices and proximal femoral nail in the management of subtrochanteric fracture femur

2020

IJOS

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Introduction: Hip is one of the important joint for locomotion in human beings. So fractures in and around hip joint are of great concern to treating surgeon and patient. We have made an attempt to evaluate these complex fractures and compared the efficacy of proximal femoral nail and extamedullary devices in treatment of subtrochanteric fracture femur. Materials and Methods: After informed consent was given, all 56 consecutive patients with subtrochanteric fracture of femur were randomized into two treatment groups. One group of patients were treated with dynamic hip screw or Dynamic condylar screw (Group I) and other group received proximal femoral nail (Group II). All procedures were performed by staff surgeons with patient supine on a fracture table. Result: The mean operative time in Group I (93.57 min) was significantly higher than in Group II (80 min) with a P value of < 0.01. Average blood loss in Group I (190.14ml) was 2.4 times higher than in Group II (78.35 ml) with a P value of 0.008. There was no significant statistical difference between the two groups with regard to general complications. Conclusion:We conclude that subtrochanteric fractures are difficult to understand and manage. We consider that the PFN is a good minimally invasive implant for unstable proximal femoral fractures when closed reduction is possible. In general, PFN afforded early return to physical activity, faster rehabilitation & walking ability, lesser blood loss and comparable success rate.

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“…Even the Cochrane library cannot give absolute answers on the best form of treatment [49,77,81,82]. This is largely a result of the paucity of studies and their poor quality in terms of outcome measures.…”

Section: Discussionmentioning

confidence: 99%

“…The Cochrane Database has concluded that the fixed nail plate has higher risks of implant breakage and fixation failure than the sliding hip screw for extracapsular hip fractures [49]. The evidence on other outcome measures is insufficient.…”

Section: Medoff Axial Compression Screwmentioning

confidence: 99%

Subtrochanteric fractures: Current management options

Craig

Maffulli

2005

Disability and Rehabilitation

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Conservative management gives satisfactory results in 56% of patients compared to 70 - 80% for operative methods. The studies on conservative methods are mostly dated, with less stringent outcome measures. Conservative management is safe, and has a low frequency of non-union. It is most applicable in regions where facilities are suboptimal, in patients unfit for surgery, and in children. When considering operative management, intramedullary devices appear to give better results than extramedullary devices, particularly when the medial buttress of the proximal femur is compromised. However, when operative treatment is undertaken, it should be by experienced surgeons using the technique with which they are most familiar.

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Condylocephalic nails versus extramedullary implants for extracapsular hip fractures

Abstract: Analysis 1.5. Comparison 1 Ender nails versus extramedullary fixation implants, Outcome 5 Cut-out of implant (odds ratio results

Cited by 29 publications

References 21 publications

Implant-related complications in the treatment of unstable intertrochanteric fractures: meta-analysis of dynamic screw-plate versus dynamic screw-intramedullary nail devices

Implant-related complications in the treatment of unstable intertrochanteric fractures: meta-analysis of dynamic screw-plate versus dynamic screw-intramedullary nail devices

Comparison of efficacy of extramedullary fixation devices and proximal femoral nail in the management of subtrochanteric fracture femur

Subtrochanteric fractures: Current management options

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