Systematic review of dynamization vs exchange nailing for delayed/non-union femoral fractures

Abstract Introduction Trochanteric femoral fractures are among the most common operatively treated fractures. Intramedullary fixation has become the treatment of choice in many centers around the world. Nevertheless, the knowledge of rare complications of these fractures is limited. In this study, the incidence and treatment strategies for peri-implant fractures (PIF) were assessed. Materials and methods A single-center retrospective cohort study was done on 987 consecutive operatively treated trochanteric fractures. PFNA cephalomedullary nail was used as a fixation method. All patients were followed up from patient records for peri-implant fractures. Plain radiographs as well as different salvage methods were analyzed and compared. Results The total rate of peri-implant fractures was 1.4% (n = 14). The rate of PIF for patients treated with short (200 mm) nails, intermediate-length (240 mm) nails, and long nails was 2.7% (n = 2), 1.5% (n = 11), and 0.7% (n = 1), respectively (ns, p > 0.05 for difference). Treatment of choice for PIF was either ORIF with locking plate (57%, n = 8) or exchange nailing (43%, n = 6). None of the PIF patients needed additional surgeries for non-union, malunion, or delayed union. Conclusions A PIF is a rare complication of intramedullary fixation of trochanteric fractures. It can be treated with either locking plates or exchange nailing with sufficient results. There are no grounds for favoring long nails to avoid PIFs.

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Non-union in lateral locked plating for distal femoral fractures: A systematic review

Injury ◽

10.1016/j.injury.2019.07.012 ◽

2019 ◽

Vol 50 (11) ◽

pp. 1790-1794 ◽

Cited By ~ 3

Author(s):

Michael Tianfeng Wang ◽

Vincent V.G. An ◽

Brahman Shankar Sivakumar

Keyword(s):

Systematic Review ◽

Femoral Fractures ◽

Locked Plating ◽

Non Union ◽

Distal Femoral Fractures

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Exchange Nailing as Revision Surgery for Post-operative Non-union of Atypical Femoral Fractures: A Case Report and Treatment Strategy

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i02.2050 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Tomohiro Yasuda ◽

Masayuki Arai ◽

Daichi Shinohara ◽

Yuki Samejima ◽

Koji Kanzaki ◽

...

Keyword(s):

Case Report ◽

Revision Surgery ◽

Femoral Fracture ◽

Callus Formation ◽

Femoral Fractures ◽

Femoral Shaft ◽

Medullary Canal ◽

Atypical Femoral Fractures ◽

Non Union ◽

Exchange Nailing

Introduction: Atypical femoral fractures account for only 0.5% of femoral shaft fractures, but delayed union or non-union occurs in 50% of atypical femoral fractures accompanied by femoral lateral bowing. Such fractures are difficult to treat. Case Report: The case was an 84-year-old woman. She was diagnosed post-operative non-union of atypical femoral fracture. We planned a revision surgery for post-operative non-union of the atypical proximal femoral fracture. A two-dimensional template was used to simulate the intramedullary nail (IMN). Due to the advanced femoral lateral bowing deformity, a mismatch with the nail was noted when the unaffected femur was used to construct the template. When the opposite side nail was used as a template, the nail was aligned with the medullary canal, and the tip of the nail coincided with the center of the medullary canal; hence, the opposite side nail was chosen. Radiographical assessments of healing of the fracture confirmed callus formation and complete bone union 3 months and 1 year after the operation, respectively. Conclusion: We found that exchange nailing as revision surgery for post-operative non-union of atypical femoral fractures combined with an IMN on the opposite side was useful. Keywords: Alendronate, femoral fracture, osteoporosis, revision surgery.

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Reunion of post nail aseptic non-union of diaphyseal femoral fractures by augmentation plating, decortication and bone grafting – Replacement for exchange nailing

Injury ◽

10.1016/j.injury.2020.10.036 ◽

2020 ◽

Author(s):

Krishna Kumar Mittal ◽

Himanshu Gupta ◽

Nitin Kaushik

Keyword(s):

Bone Grafting ◽

Femoral Fractures ◽

Non Union ◽

Exchange Nailing ◽

Augmentation Plating

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Mortality escalates in patients of proximal femoral fractures with COVID-19: A systematic review and meta-analysis of 35 studies on 4225 patients

Journal of Clinical Orthopaedics and Trauma ◽

10.1016/j.jcot.2021.03.023 ◽

2021 ◽

Author(s):

Mohit Kumar Patralekh ◽

Vijay Kumar Jain ◽

Karthikeyan P. Iyengar ◽

Gaurav Kumar Upadhyaya ◽

Raju Vaishya

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Femoral Fractures ◽

Proximal Femoral Fractures

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Union rates and functional outcome of double plating of the femur: systematic review of the literature

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-03767-6 ◽

2021 ◽

Author(s):

M. F. Lodde ◽

M. J. Raschke ◽

J. Stolberg-Stolberg ◽

J. Everding ◽

S. Rosslenbroich ◽

...

Keyword(s):

Systematic Review ◽

Fracture Healing ◽

Functional Outcome ◽

Femoral Fractures ◽

Periprosthetic Fractures ◽

Level Of Evidence ◽

Distal Femoral Fractures ◽

Femur Fractures ◽

Meta Analyses ◽

Double Plating

Abstract Background The optimal treatment strategy for the surgical management of femur fractures and non-unions remains unknown. The aim of this study is to assess union rates, complications and outcome after femoral double plating. Treatment of shaft, distal, periprosthetic fractures and pathological proximal femur fractures as well as femoral non-unions with double plating were evaluated. Methods A systematic review according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement was conducted. Published literature reporting on the treatment and clinical outcome of femoral fractures and non-unions with double plating was identified. In total, 24 studies with 436 cases of double plating, 64 cases of single plating, 84 cases of intramedullary nailing (IM), and 1 interfragmentary screw treatment met the inclusion criteria of this systematic review. The evaluated literature was published between 1991 and 2020. Results Double plating of femoral fractures achieved high healing rates and few complications were reported. It displayed significantly less intraoperative haemorrhage, shorter surgery time reduced risk of malunion in polytraumatised patients when compared to IM. Fracture healing rate of double-plating distal femoral fractures was 88.0%. However, there were no significant differences regarding fracture healing, complication or functional outcome when compared to single plating. Treatment of periprosthetic fractures with double plating displayed high healing rates (88.5%). Double plating of non-unions achieved excellent osseous union rates (98.5%). Conclusions The literature provides evidence for superior outcomes when using double plating in distal femoral fractures, periprosthetic fractures and femoral non-unions. Some evidence suggests that the use of double plating of femoral fractures in polytraumatised patients may be beneficial over other types of fracture fixation. Level of evidence IV.

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Integrated dual lag screws versus single lag screw cephalomedullary nail constructs: a meta-analysis and systematic review

Hip International ◽

10.1177/1120700020985067 ◽

2021 ◽

pp. 112070002098506

Author(s):

James R Onggo ◽

Mithun Nambiar ◽

Jason D Onggo ◽

Anuruban Ambikaipalan ◽

Parminder J Singh ◽

...

Keyword(s):

Functional Outcomes ◽

Meta Analysis ◽

Femoral Fractures ◽

Harris Hip Score ◽

Complication Rates ◽

Non Union ◽

Lag Screw ◽

Significant Difference ◽

Lower Complication ◽

Cephalomedullary Nails

Background/Aim: This study aims to determine the safety and efficacy of integrated dual lag screw (IDL) cephalomedullary nails (CMN) when compared with single lag screw (SL) constructs, in the internal fixation of intertrochanteric femoral fractures. Methods: The Smith & Nephew InterTan IDL was compared with SL CMN group consisting of the Stryker Gamma-3 (G3) and Synthes Proximal Femoral Nail Antirotation (PFNA) CMN. A multi-database search was performed according to PRISMA guidelines. Data from studies assessing the clinical and radiological outcomes, complications and perioperative parameters of InterTan versus G3 or PFNA CMN in patients with intertrochanteric femoral fractures were extracted and analysed. Results: 15 studies were included in this meta-analysis, consisting of 2643 patients. InterTan was associated with lower complication rates in terms of all-cause revisions (OR 0.34; 95% CI, 0.22–0.51; p < 0.001), cut-outs (OR 0.30; 95% CI, 0.17–0.51; p < 0.001), medial or lateral screw migration (OR 0.19; 95% CI, 0.06–0.65; p = 0.008) as well as persistent hip and thigh pain (OR 0.65; 95% CI, 0.47–0.90; p = 0.008). In terms of perioperative parameters, InterTan is associated with longer operative times (MD 5.57 minutes; 95% CI, 0.37–10.78 minutes, p = 0.04) and fluoroscopy times (MD 38.89 seconds, 95% CI, 15.88–61.91 seconds; p < 0.001). There was no statistically significant difference in terms of clinical Harris Hip Score and radiological outcomes, non-union, haematoma, femoral fractures, varus collapse, length of stay and mean intraoperative blood loss between the 2 groups. Conclusions: Integrated dual lag screw cephalomedullary nails are associated with fewer revisions and complications. However, there is insufficient data to suggest that either nail construct is associated with better functional outcomes.

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Arthrodesis of First Metatarsophalangeal Joint by Plate and Screws for Treatment of Hallux Rigidus (Systematic Review and Meta-Analysis)

QJM ◽

10.1093/qjmed/hcab104.016 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Ossama Abdelraoof El Shazly ◽

Mohamed Mokhtar Abdellah ◽

Mostafa Abdelnabee Abouzaid

Keyword(s):

Systematic Review ◽

Observational Studies ◽

Plate Fixation ◽

Meta Analysis ◽

Metatarsophalangeal Joint ◽

Hallux Rigidus ◽

Superficial Infection ◽

First Metatarsophalangeal Joint ◽

Non Union ◽

Meta Analyses

Abstract Background With continued loss of dorsiflexion of the 1st MTP, degenerative changes occur within the joint with severe restriction of movement and increase in pain, which leads to the condition known as hallux rigidus. The amount of dorsiflexion may be reduced to 0-10 degrees with pain on both active and passive motion. Objectives Systematically reviewing available evidence from published articles to assess the effectiveness of arthrodesis of first metatarsophalangeal joint by plate and screws in hallux rigidus. The assessment also would encompass safety, side effects, and complications of this mode of treatment. Materials and Methods We performed this systematic review and meta-analysis in accordance to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) statement. PRISMA and MOOSE are reporting checklists for Authors, Editors, and Reviewers of Meta-analyses of interventional and observational studies. According to International committee of medical journal association (ICJME), reviewers must report their findings according to each of the items listed in those checklists. Results Previous results for arthrodesis have been favourable with a union rate of almost 96%. In the present systematic review and meta-analysis, the overall effect estimates showed that the union rates after plate and screw arthrodesis for 1st MTPJ was 96.2% (95% CI 94 – 98.4%). In addition, the overall effect estimates showed that the non-union rates after plate and screw arthrodesis for 1st MTPJ was 4.2% (95% CI 2.4 – 6.1%). Moreover, the overall effect estimates showed that the satisfaction rates after plate and screw arthrodesis for 1st MTPJ was 94.5% (95% CI 90 – 99%). In the present study, the overall effect estimates showed that the overall complications rate after plate and screw arthrodesis for 1st MTPJ was 7.2% (95% CI 2.5 – 12%). The overall effect estimates showed that the malunion rates after plate and screw arthrodesis for 1st MTPJ was 2.7% (95% CI 0 – 6.4%). Additionally, the overall effect estimates showed that the hardware removal and superficial infection rates after plate and screw arthrodesis for 1st MTPJ were 2% and 2.9%, respectively. Conclusion Our analysis showed that plate and screws fixation is effective techniques that can be used for first MTPJ arthrodesis in patients with hallux rigidus. We found that the screw and plate fixation has a significantly lower rate of nonunion compared with the screw alone, as reported by the literature. However, owing to the small group sizes and methodologic shortcomings, we were unable to identify the clinically superior fixation technique for first MTPJ arthrodesis arthrodesis.

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The Treatment of Acute Diaphyseal Long-bones Fractures with Orthobiologics and Pharmacological Interventions for Bone Healing Enhancement: A Systematic Review of Clinical Evidence

Bioengineering ◽

10.3390/bioengineering7010022 ◽

2020 ◽

Vol 7 (1) ◽

pp. 22

Author(s):

Giuseppe Marongiu ◽

Andrea Contini ◽

Andrea Cozzi Lepri ◽

Matthew Donadu ◽

Marco Verona ◽

...

Keyword(s):

Systematic Review ◽

Growth Factors ◽

Bone Healing ◽

Healing Process ◽

Bone Matrix ◽

Femoral Fractures ◽

Current Evidence ◽

Long Bones ◽

Cell Therapies ◽

Diaphyseal Fractures

Background: The healing of long bones diaphyseal fractures can be often impaired and eventually end into delayed union and non-union. A number of therapeutic strategies have been proposed in combination with surgical treatment in order to enhance the healing process, such as scaffolds, growth factors, cell therapies and systemic pharmacological treatments. Our aim was to investigate the current evidence of bone healing enhancement of acute long bone diaphyseal fractures. Methods: A systematic review was conducted by using Pubmed/MEDLINE; Embase and Ovid databases. The combination of the search terms “long-bones; diaphyseal fracture; bone healing; growth factors; cell therapies; scaffolds; graft; bone substitutes; orthobiologics; teriparatide”. Results: The initial search resulted in 4156 articles of which 37 papers fulfilled the inclusion criteria and were the subject of this review. The studies included 1350 patients (837 males and 513 females) with a mean age of 65.3 years old. Conclusions: General lack of high-quality studies exists on the use of adjuvant strategies for bone healing enhancement in acute shaft fractures. Strong evidence supports the use of bone grafts, while only moderate evidence demineralized bone matrix and synthetic ceramics. Conflicting results partially supported the use of growth factors and cell therapies in acute fractures. Teriparatide showed promising results, particularly for atypical femoral fractures and periprosthetic femoral fractures.

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