Is distal locking with short intramedullary nails necessary in stable pertrochanteric fractures? A prospective, multicentre, randomised study

Caiaffa, Vincenzo; Vicenti, Giovanni; Mori, Claudio; Panella, Antonio; Conserva, Vito; Corina, G.; Scialpi, L.; Abate, Antonella; Carrozzo, M; Petrelli, L.; Picca, Girolamo; Aloisi, A.; Rollo, Giuseppe; Filipponi, Marco; Freda, V.; Pansini, Andrea; Puce, A.; Solarino, Giuseppe; Moretti, Biagio

doi:10.1016/j.injury.2016.07.038

Cited by 27 publications

(57 citation statements)

References 40 publications

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“…Although our models suggest that screw fixation was a significant predictor of both axial and shear interfragmentary motion, the differences in motion with and without screw fixation were small except for in subtrochanteric fracture types. Furthermore, clinical data from 333 patients indicated that stable pertrochanteric and intertrochanteric fractures can be treated with short IM nails without distal locking screws without increasing mortality nor hospital length of stay, supporting the nail length and screw fixation findings of our model …”

Section: Discussionsupporting

confidence: 73%

Parametric Finite Element Analysis of Intramedullary Nail Fixation of Proximal Femur Fractures

Tucker

Wee

Fox

et al. 2019

Journal Orthopaedic Research

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Proximal femur fracture fixation with intramedullary nailing relies on stability at the fracture site and integrity of the fixation construct to achieve union. The biomechanics that dictate fracture site stability and implant stress depend on fracture type as well as implant features such as nail length, nail diameter, presence of distal fixation screws, and material composition of the implant. When deciding how to fix a fracture, surgeons have choices in these implant‐related design variables. This study models all combinations of a range of implant variables for nine standard AO/OTA proximal femur fractures using finite element analysis. Under simulated maximum load during gait, the maximum stress in the implant and screws as well as interfragmentary motions at the fracture site in the axial and shear directions were computed. The results were separated by fracture type to show the influence of each design variable on measured biomechanical outcomes. Filling the reamed canal with the largest fitting nail diameter reduced axial and shear interfragmentary motion for all fracture types. Nail length was less predictive of shear interfragmentary motion for most simulated fracture types than other construct variables. Furthermore, gapping at the fracture site predisposed the construct to higher implant stresses and larger interfragmentary motions. Clinical significance: Biomechanical outcomes from this computational study can aid in surgical decision‐making for optimizing hip fracture fixation with IM nailing. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2358–2366, 2019

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Section: Discussionsupporting

confidence: 73%

Parametric Finite Element Analysis of Intramedullary Nail Fixation of Proximal Femur Fractures

Tucker

Wee

Fox

et al. 2019

Journal Orthopaedic Research

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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%

“…Quality of the included studies was assessed separately according to the study design and the results are presented in Tables S1 and S2. For RCTs, random sequence generation was well performed in all of the four studies . Allocation concealment was applied in three studies while unclear in only one study .…”

Section: Resultsmentioning

confidence: 99%

“…No blinding of investigator was identified among these RCTs, but there were fewer tendencies to influence the primary measures. 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%

“…Three studies ( n = 480) reported total fluoroscopy exposure time during surgery and statistically significant less time was needed in DUL group (SMD 1.44, 95% CI 0.46–2.41; Fig. ).…”

Section: Resultsmentioning

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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Surgical interventions for treating extracapsular hip fractures in older adults: a network meta-analysis

Lewis

Macey

Lewis

et al. 2022

Cochrane Database of Systematic Reviews

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BackgroundHip fractures are a major healthcare problem, presenting a challenge and burden to individuals and healthcare systems. The number of hip fractures globally is rising. The majority of extracapsular hip fractures are treated surgically. ObjectivesTo assess the relative e ects (benefits and harms) of all surgical treatments used in the management of extracapsular hip fractures in older adults, using a network meta-analysis of randomised trials, and to generate a hierarchy of interventions according to their outcomes. Search methodsWe searched CENTRAL, MEDLINE, Embase, Web of Science and five other databases in July 2020. Selection criteriaWe included randomised controlled trials (RCTs) and quasi-RCTs comparing di erent treatments for fragility extracapsular hip fractures in older adults. We included internal and external fixation, arthroplasties and non-operative treatment. We excluded studies of hip fractures with specific pathologies other than osteoporosis or resulting from high-energy trauma. Data collection and analysisTwo review authors independently assessed studies for inclusion. One review author completed data extraction which was checked by a second review author. We collected data for three outcomes at di erent time points: mortality and health-related quality of life (HRQoL)both reported within 4 months, at 12 months and a er 24 months of surgery, and unplanned return to theatre (at end of study follow-up).We performed a network meta-analysis (NMA) with Stata so ware, using frequentist methods, and calculated the di erences between treatments using risk ratios (RRs) and standardised mean di erences (SMDs) and their corresponding 95% confidence intervals (CIs). We also performed direct comparisons using the same codes. Surgical interventions for treating extracapsular hip fractures in older adults: a network meta-analysis (Review)

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Is distal locking with short intramedullary nails necessary in stable pertrochanteric fractures? A prospective, multicentre, randomised study

Cited by 27 publications

References 40 publications

Parametric Finite Element Analysis of Intramedullary Nail Fixation of Proximal Femur Fractures

Parametric Finite Element Analysis of Intramedullary Nail Fixation of Proximal Femur Fractures

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

Surgical interventions for treating extracapsular hip fractures in older adults: a network meta-analysis

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