Unlocked versus dynamic and static distal locked femoral nails in stable and unstable intertrochanteric fractures. A prospective study

Ciaffa, V.; Vicenti, Giovanni; Mori, Claudio; Panella, Antonio; Conserva, Vito; Corina, G.; Scialpi, L.; Speciale, M.; Fraccascia, A.; Picca, Girolamo; Carrozzo, M; Leone, Andrea; Morizio, Arcangelo; Abate, Antonella; Petrelli, L.; Aloisi, A.; Rollo, Giuseppe; Filipponi, Marco; Freda, V.; Pansini, Andrea; Puce, A.; Sorce, Gabriele; Solarino, Giuseppe; Moretti, Biagio

doi:10.1016/j.injury.2018.09.063

Cited by 26 publications

(56 citation statements)

References 24 publications

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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%

“…Moreover, it is estimated that approximately $62 per minute and 12 min are needed to lock an intramedullary nail in American operation room. Thus, the additional expenditures were considerable due to the high incidence of hip fractures . Similarly, the additional fluoroscopy exposure of medical staff caused by setting the locking screws should also be noted, although meeting government regulations.…”

Section: Discussionmentioning

confidence: 99%

“…Our meta‐analysis suggested significantly more thigh pain occurred in DL group and that can be explained by stress riser or iliotibial tract irritation. But for stable fractures, the stress placed on locking screws is little and therefore related complications are rare …”

Section: Discussionmentioning

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%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

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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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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The inverted Vancouver C fracture. Case series of unstable proximal femur fractures above a knee revision stem treated by short cephalomedullary nail and lateral submuscular overlapping plate

Andrés-Peiró

Ruiz

Hernández

et al. 2020

Eur J Orthop Surg Traumatol

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Unlocked versus dynamic and static distal locked femoral nails in stable and unstable intertrochanteric fractures. A prospective study

Cited by 26 publications

References 24 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

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

The inverted Vancouver C fracture. Case series of unstable proximal femur fractures above a knee revision stem treated by short cephalomedullary nail and lateral submuscular overlapping plate

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