TY - JOUR
T1 - Extramedullary versus intramedullary fixation of stable trochanteric femoral fractures
T2 - a systematic review and meta-analysis
AU - Zeelenberg, Miliaan L.
AU - Nugteren, Leendert H. T.
AU - Plaisier, A. Cornelis
AU - Loggers, Sverre A. I.
AU - Joosse, Pieter
AU - den Hartog, Dennis
AU - Verhofstad, Michael H. J.
AU - van Lieshout, Esther M. M.
AU - STABLE-HIP Study Group
AU - Gosens, Taco
AU - Hegeman, Johannes H.
AU - Polinder, Suzanne
AU - Poolman, Rudolf W.
AU - Willems, Hanna C.
AU - Zuurmond, Rutger G.
N1 - Funding Information: STABLE-HIP Study Group: Taco Gosens, MD PhD, Department of Orthopedics, Elisabeth-TweeSteden Hospital (ETZ), Tilburg, The Netherlands; Johannes H. Hegeman, MD PhD, Department of Surgery, Zorg Groep Twente (ZGT), Almelo, The Netherlands; Suzanne Polinder, PhD, Department of Public Health, Erasmuc MC, Rotterdam, The Netherlands; Rudolf W. Poolman, MD PhD, Department of Orthopedics, OLVG Hospital, Amsterdam, The Netherlands; Hanna C. Willems, MD PhD, Department of Geriatrics, Amsterdam University Medical Center, Amsterdam, The Netherlands; Rutger G. Zuurmond, MD PhD, Department of Orthopedics, Isala Hospital, Zwolle, The Netherlands Publisher Copyright: © 2023, The Author(s).
PY - 2023/8/1
Y1 - 2023/8/1
N2 - Objective: This systematic review and meta-analysis compared extramedullary fixation and intramedullary fixation for stable two-part trochanteric femoral fractures (AO type 31-A1) with regards to functional outcomes, complications, and surgical outcomes. Methods: Embase, Medline, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar were searched for randomized controlled trials (RCTs) and observational studies. Effect estimates were pooled across studies using random effects models. Results were presented as weighted risk ratio (RR) or weighted mean difference (MD) with corresponding 95% confidence interval (95% CI). Results: Five RCTs (397 patients) and 14 observational studies (21,396 patients) were included. No significant differences in functional outcomes, complications, or surgical outcomes were found between extramedullary and intramedullary fixation devices, except for a difference in duration of surgery (MD 14.1 min, CI 5.76–22.33, p < 0.001) and intra-operative blood loss (MD 92.30 mL, CI 13.49–171.12, p = 0.02), favoring intramedullary fixation. Conclusion: Current literature shows no meaningful differences in complications, surgical, or functional outcomes between extramedullary and intramedullary fixation of stable two-part trochanteric femoral fractures. Both treatment options result in good outcomes. This study implicates that, costs should be taken into account when considering implants or comparing fixation methods in future research.
AB - Objective: This systematic review and meta-analysis compared extramedullary fixation and intramedullary fixation for stable two-part trochanteric femoral fractures (AO type 31-A1) with regards to functional outcomes, complications, and surgical outcomes. Methods: Embase, Medline, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar were searched for randomized controlled trials (RCTs) and observational studies. Effect estimates were pooled across studies using random effects models. Results were presented as weighted risk ratio (RR) or weighted mean difference (MD) with corresponding 95% confidence interval (95% CI). Results: Five RCTs (397 patients) and 14 observational studies (21,396 patients) were included. No significant differences in functional outcomes, complications, or surgical outcomes were found between extramedullary and intramedullary fixation devices, except for a difference in duration of surgery (MD 14.1 min, CI 5.76–22.33, p < 0.001) and intra-operative blood loss (MD 92.30 mL, CI 13.49–171.12, p = 0.02), favoring intramedullary fixation. Conclusion: Current literature shows no meaningful differences in complications, surgical, or functional outcomes between extramedullary and intramedullary fixation of stable two-part trochanteric femoral fractures. Both treatment options result in good outcomes. This study implicates that, costs should be taken into account when considering implants or comparing fixation methods in future research.
KW - AO type 31-A1
KW - Extramedullary
KW - Hip fracture
KW - Intramedullary
KW - Trochanteric
UR - http://www.scopus.com/inward/record.url?scp=85156260765&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00402-023-04902-1
DO - https://doi.org/10.1007/s00402-023-04902-1
M3 - Article
C2 - 37129692
SN - 0936-8051
VL - 143
SP - 5065
EP - 5083
JO - Archives of Orthopaedic and Trauma Surgery
JF - Archives of Orthopaedic and Trauma Surgery
IS - 8
ER -