Nail-plate combination constructs versus single traditional constructs for distal femur fractures: a systematic review and meta-analysis of comparative studies

IF 2 3区医学 Q2 ORTHOPEDICS

Archives of Orthopaedic and Trauma Surgery Pub Date : 2024-12-23 DOI:10.1007/s00402-024-05723-6

Anthony N. Baumann, Mathias A. Uhler, Jay Fiechter, Albert T. Anastasio, Kempland C. Walley, Atticus Coscia, Mark E. Hake

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引用次数: 0

Abstract

Objectives

Distal femur fractures (DFF) are frequently treated surgically with single traditional constructs (STC), such as with a lateral plate or intramedullary nail, although nail-plate combination constructs (NPCC) are gaining attention. The purpose of this study is to compare outcomes between NPCC and STC for surgical fixation of DFF to guide surgeon decision-making.

Methods

Data Sources: This study is a systematic review and meta-analysis using PubMed, CINAHL, MEDLINE, Web of Science, Science Direct, and SPORTDiscus from database inception until January 10th, 2024. Study Selection: Inclusion criteria were comparative studies that examined clinical outcomes and complications for NPCC versus STC for DFF in adult patients. Data Extraction: Data included operative time, estimated blood loss (EBL), length of stay (LOS), as well as likelihood of total complications, total unplanned reoperations, and malunion. Data Synthesis: Statistical analysis included a random-effects model using unstandardized mean difference or odds ratio (OR).

Results

Five retrospective comparative studies (n = 1,368 patients; mean age: 52.3 ± 8.1 years; 134 patients in the NPCC group) were included. There was no statistically significant difference in operative time (p = 0.696), EBL (p = 0.408), or LOS (p = 0.963) between patients in the NPCC group as compared to patients in the STC group after DFF. Patients in the NPCC group had a statistically significant lower number of total complications (p = 0.009; OR: 0.31; 10.6% versus 16.0%) and total unplanned reoperations (p = 0.027; OR: 0.42; 8.2% versus 14.8%) as compared to patients in the STC group after DFF. However, there was no statistically significant difference in the number of malunion cases between groups (p = 0.130), although the NPCC group had far fewer cases than the STC group (2.9% versus 10.5%).

Conclusion

Patients treated with NPCC had significantly fewer cases of total complications and total unplanned reoperations without significant differences in operative time, EBL, or LOS as compared to patients treated with STC for DFF, although these associations are limited by sample size.

Level of evidence

Level IV.

Abstract Image

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股骨远端骨折的钉钢板联合支架与单一传统支架：比较研究的系统回顾和荟萃分析

目的股骨远端骨折（DFF）通常采用单一传统支架（STC）进行手术治疗，如外侧钢板或髓内钉，尽管钉-板联合支架（NPCC）越来越受到关注。本研究的目的是比较NPCC和STC在DFF手术固定中的效果，以指导外科医生的决策。方法数据来源：本研究是对PubMed、CINAHL、MEDLINE、Web of Science、Science Direct和SPORTDiscus从数据库建立到2024年1月10日的系统综述和荟萃分析。研究选择：纳入标准是比较研究，检查成人DFF患者NPCC与STC的临床结果和并发症。数据提取：数据包括手术时间、估计失血量（EBL）、住院时间（LOS）、总并发症的可能性、总计划外再手术和畸形愈合。数据综合：统计分析包括使用非标准化平均差异或比值比（or）的随机效应模型。结果5项回顾性比较研究(n = 1368例；平均年龄：52.3±8.1岁；纳入NPCC组134例。与STC组相比，NPCC组DFF术后手术时间（p = 0.696）、EBL （p = 0.408）、LOS （p = 0.963）差异均无统计学意义。NPCC组患者的总并发症数有统计学意义(p = 0.009；OR: 0.31;10.6%对16.0%)和计划外再手术总数(p = 0.027；OR: 0.42;8.2%对14.8%)，与DFF后STC组患者相比。然而，尽管NPCC组的病例数远少于STC组（2.9%比10.5%），但两组间的不愈合病例数差异无统计学意义（p = 0.130）。结论与STC治疗DFF的患者相比，NPCC治疗的患者总并发症和总计划外再手术明显减少，手术时间、EBL或LOS无显著差异，尽管这些关联受样本量的限制。证据等级：四级。

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

Archives of Orthopaedic and Trauma Surgery 医学-外科

CiteScore

4.30

自引率

13.00%

发文量

424

审稿时长

2 months

期刊介绍： "Archives of Orthopaedic and Trauma Surgery" is a rich source of instruction and information for physicians in clinical practice and research in the extensive field of orthopaedics and traumatology. The journal publishes papers that deal with diseases and injuries of the musculoskeletal system from all fields and aspects of medicine. The journal is particularly interested in papers that satisfy the information needs of orthopaedic clinicians and practitioners. The journal places special emphasis on clinical relevance. "Archives of Orthopaedic and Trauma Surgery" is the official journal of the German Speaking Arthroscopy Association (AGA).