Non-unions and wound infections do not differ following intramedullary nailing and plate osteosynthesis for distal third femur fractures: a meta-analysis.

IF 4.3 2区医学 Q1 ORTHOPEDICS

Efort Open Reviews Pub Date : 2024-03-05 DOI:10.1530/EOR-22-0140

Andreas Frodl, Johannes Hauss, Andreas Fuchs, Markus Siegel, Hagen Schmal, Jan Kühle

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引用次数: 0

Abstract

Purpose: The fixation method of distal, extra-articular femur fractures is a controversially discussed. To ensure better stability itself, earlier mobilization and to prevent blood loss - all these are justifications for addressing the femur via reamed intramedullary nailing (RIMN). Anatomical reposition of multifragmentary fractures followed by increased risks of non-union are compelling reasons against it. The purpose of this study was to systematically review the literature for rates of non-union and wound infection, as well as blood loss and time of surgery.

Methods: According to the PRISMA guidelines we conducted this systematic review by searching the Cochrane, PubMed, Ovid, MedLine, and Embase databases. Inclusion criteria were the modified Coleman methodology score (mCMS) >60, age >18 years, and extra-articular fractures of the distal femur. Biomechanical and animal studies were excluded. By referring to title and abstract relevant articles were reviewed independently. In the consecutive meta-analysis, we compared 9 studies and 639 patients.

Results: There is no statistically significant difference comparing superficial wound infections when RIMN was performed (OR = 0.50; 95% CI: 0.18 - 1.42; P = 0.19) as well as in deep wound infections (OR = 0.74; 95% CI: 0.19-2.81; P = 0.62). However, these results were not significant. We also calculated for potential differences in the rate of non-unions depending on the surgical treatment applied. Data of 556 patients revealed an overall number of 43 non-unions. There was no significant difference in rate of non-unions between both groups (OR = 0.97; 95% CI: 0.51-1.85; P = 0.92).

Conclusion: No statistical difference was found in our study among RIMN and plate fixation in the treatment of distal femoral fractures with regard to the incidence of non-union and wound infections. Therefore, the indication for RIMN or plating should be made individually and based on the surgeon's experience.

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髓内钉和钢板骨合成术治疗股骨远端第三节骨折后，非愈合和伤口感染情况并无不同：一项荟萃分析。

目的：关于股骨远端关节外骨折的固定方法，一直存在争议。为了确保更好的稳定性、更早地活动和防止失血，所有这些都是通过铰接髓内钉（RIMN）处理股骨的理由。而多节段骨折的解剖复位以及不愈合风险的增加则是令人信服的反对理由。本研究的目的是系统回顾有关不愈合率、伤口感染率、失血量和手术时间的文献：根据 PRISMA 指南，我们在 Cochrane、PubMed、Ovid、MedLine 和 Embase 数据库中进行了检索，从而开展了这项系统性综述。纳入标准为改良科尔曼方法学评分（mCMS）大于 60 分、年龄大于 18 岁、股骨远端关节外骨折。生物力学和动物研究除外。通过参考标题和摘要，对相关文章进行了独立审查。在连续荟萃分析中，我们对 9 项研究和 639 名患者进行了比较：进行 RIMN 治疗时，浅表伤口感染（OR = 0.50；95% CI：0.18 - 1.42；P = 0.19）和深部伤口感染（OR = 0.74；95% CI：0.19-2.81；P = 0.62）的差异无统计学意义。然而，这些结果并不显著。我们还计算了因手术治疗方法不同而导致的非椎体畸形率的潜在差异。556 例患者的数据显示，非塌陷的总数为 43 例。两组患者的非塌陷率无明显差异（OR = 0.97；95% CI：0.51-1.85；P = 0.92）：我们的研究发现，在治疗股骨远端骨折时，RIMN固定和钢板固定在非愈合和伤口感染发生率方面没有统计学差异。因此，RIMN 或钢板固定的适应症应根据外科医生的经验单独制定。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Efort Open Reviews Medicine-Orthopedics and Sports Medicine

CiteScore

6.60

自引率

2.90%

发文量

101

审稿时长

13 weeks

期刊介绍： EFORT Open Reviews publishes high-quality instructional review articles across the whole field of orthopaedics and traumatology. Commissioned, peer-reviewed articles from international experts summarize current knowledge and practice in orthopaedics, with the aim of providing systematic coverage of the field. All articles undergo rigorous scientific editing to ensure the highest standards of accuracy and clarity. This continuously published online journal is fully open access and will provide integrated CME. It is an authoritative resource for educating trainees and supports practising orthopaedic surgeons in keeping informed about the latest clinical and scientific advances. One print issue containing a selection of papers from the journal will be published each year to coincide with the EFORT Annual Congress. EFORT Open Reviews is the official journal of the European Federation of National Associations of Orthopaedics and Traumatology (EFORT) and is published in partnership with The British Editorial Society of Bone & Joint Surgery.