Distal locking in short hip nails: Cause or prevention of peri-implant fractures?

Skála-Rosenbaum, J; Džupa, Valér; Bartoška, Radek; Douša, Pavel; Waldauf, Petr; Krbec, Martin

doi:10.1016/j.injury.2016.02.009

Cited by 31 publications

(47 citation statements)

References 26 publications

(34 reference statements)

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“…About 25 studies were considered as potentially eligible for further assessment after scanning titles and abstracts. Finally, eight trials were included after full text were carefully reviewed …”

Section: Resultsmentioning

confidence: 99%

“…In addition, all the RCTs reported and explained the dropout and were at risk of neither selecting bias nor other bias . For the quality of observational studies assessed using the Newcastle Ottawa Scale, one study with score of 4 was considered as high risk of bias and the other two studies scored 6 and 7 presented low risk of bias.…”

Section: Resultsmentioning

confidence: 99%

“…Finally, eight trials were included after full text were carefully reviewed. 1,5,[15][16][17][18][19][20]…”

Section: Study Selectionmentioning

confidence: 99%

“…These researches were conducted in China, 16 Italy, 1,15,19 Spain, 20 USA 18 and Czech. 5,17 Among the included studies, four were RCTs, 15,16,19,20 three were case-control studies 5,17,18 and the other one was prospective cohort study. 1 The number of participants enrolled in individual study ranged from 70 to 849 and totally 1874 (748 in DL group and 1126 in distal unlocking (DUL) group) intertrochanteric fractures treated with intramedullary nailing were included in this meta-analysis.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

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Distal locked or unlocked nailing for stable intertrochanteric fractures? A meta‐analysis

Yan

Cao

Sun

et al. 2019

ANZ Journal of Surgery

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Background To date, there are just several studies comparing distal locked nails with distal unlocked nails in treating intertrochanteric fractures. We report the first meta‐analysis about this issue. Methods Systematic search was conducted for studies in PubMed, Embase and Cochrane Library. Meta‐analyses were performed regarding intra operative outcomes, complications and functional outcomes. Results Pooled results showed insignificant difference between distal locking group and distal unlocking group in hip pain (relative risk (RR) 1.14, 95% confidence interval (CI) 0.59–2.19), distal tip fracture (RR 1.08, 95% CI 0.37–3.11), lag screw cut‐out (RR 1.60, 95% CI 0.54–4.78), delayed or nonunion (RR 1.32, 95% CI 0.25–7.06), deep vein thrombosis (RR 1.06, 95% CI 0.23–4.84), wound infection (RR 0.58, 95% CI 0.28–1.22), Harris hip score (standard mean deviation (SMD) 0.03, 95% CI −0.15 to 0.21) and walking ability. However, significant difference was detected in operation time (SMD 0.77, 95% CI 0.36–1.17), fluoroscopy exposure time (SMD 1.02, 95% CI 0.52–1.52), blood loss (SMD 0.80, 95% CI 0.62–0.99) and total incision length (SMD 1.16, 95% CI 0.86–1.47). Result of trial sequential analysis indicated conclusive evidence. Conclusion Current evidence indicates that the distal locked intramedullary nails should not be recommended as routine choice for stable intertrochanteric fractures.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Finally, eight trials were included after full text were carefully reviewed. 1,5,[15][16][17][18][19][20]…”

Section: Study Selectionmentioning

confidence: 99%

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

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Distal locked or unlocked nailing for stable intertrochanteric fractures? A meta‐analysis

Yan

Cao

Sun

et al. 2019

ANZ Journal of Surgery

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“…Another 10 unrelated biomechanical studies were excluded after further reading. Finally, 9 studies (4 randomized controlled trials [12][13][14][15] and 5 observation studies [16][17][18][19][20]) met our inclusion and exclusion criteria, including 7 in English [12][13][14][16][17][18][19], 1 in Spanish [15], and 1 in Korean [20] (Fig. 1).…”

Section: Study Characteristics and Quality Assessmentmentioning

confidence: 99%

Distal locked versus unlocked intramedullary nailing for stable intertrochanteric fractures, a systematic review and meta-analysis

Shao³

et al. 2020

Preprint

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Background: Intramedullary nails have become the main treatment for intertrochanteric fractures. However, a distal locking procedure during nailing gradually raised controversy. In this study, a systematic review and meta-analysis of clinical trials was performed to summarize existing evidence, aiming to determine the safety and efficacy of distal locking or unlocking in the nailing of stable intertrochanteric fractures. Methods: Appropriate articles were identified using the most common public databases, such as PubMed, Embase, the Cochrane Library, and Google Scholar from the inception of each database to April 2019, without restriction of language, publication date, and considering ongoing trials. Eligible studies were represented by randomized controlled trials or retrospective cohort studies, comparing distal locking and unlocking for the treatment of acute stable intertrochanteric fractures in adult patients. Information regarding methodological quality, patient demographics, and clinical outcomes were extracted independently by two reviewers. Subsequently, patients were divided into a locking and unlocking group.Results: This study included 9 articles, comprising a total of 1978 patients with a similar baseline. The results showed that the unlocking group had a shorter operation time, less intraoperative bleeding, lower transfusion rate, and less thigh pain after the treatment of femoral intertrochanteric fracture when compared with the distal locking group. No significant differences were observed in safety-related outcomes, including mortality, infection rate, cutting out, loss of reduction, backing out of lag screws, cephalic screw breakage, nail breakage, and peri-implant fractures between the two groups. In addition, efficacy-related outcomes including nonunion, delayed healing rates, and the Harris functional score were not significantly different between the two groups. Conclusions: Our pooled analysis demonstrated that distal unlocking of stable intertrochanteric fractures can shorten the operation time, reduce intraoperative bleeding, and reduce the blood transfusion rate. The use of locked or unlocked intramedullary nailing does not affect long-term outcomes regarding complications and function.

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Therapy aspects of peri-implant femoral fractures—a retrospective analysis of 64 patients

Wulbrand,

Müller,

Füchtmeier

et al. 2024

Eur J Trauma Emerg Surg

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Distal locking in short hip nails: Cause or prevention of peri-implant fractures?

Cited by 31 publications

References 26 publications

Distal locked or unlocked nailing for stable intertrochanteric fractures? A meta‐analysis

Distal locked or unlocked nailing for stable intertrochanteric fractures? A meta‐analysis

Distal locked versus unlocked intramedullary nailing for stable intertrochanteric fractures, a systematic review and meta-analysis

Therapy aspects of peri-implant femoral fractures—a retrospective analysis of 64 patients

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