Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults
- 8 September 2010
- journal article
- review article
- Published by Wiley in Cochrane Database of Systematic Reviews
- No. 9,p. CD000093
- https://doi.org/10.1002/14651858.cd000093.pub5
Abstract
Background Two types of implants used for the surgical fixation of extracapsular hip fractures are cephalocondylic intramedullary nails, which are inserted into the femoral canal proximally to distally across the fracture, and extramedullary implants (e. g. the sliding hip screw). Objectives To compare cephalocondylic intramedullary nails with extramedullary implants for extracapsular hip fractures in adults. Search strategy We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (April 2010), The Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 1), MEDLINE (1950 to March 2010), EMBASE (1980 to 2010 Week 13), and other sources. Selection criteria All randomised and quasi-randomised controlled trials comparing cephalocondylic nails with extramedullary implants for extracapsular hip fractures. Data collection and analysis Both authors independently assessed trial quality and extracted data. Wherever appropriate, results were pooled. Main results We included 43 trials containing predominantly older people with mainly trochanteric fractures. Twenty-two trials (3749 participants) compared the Gamma nail with the sliding hip screw (SHS). The Gamma nail was associated with increased risk of operative and later fracture of the femur and increased reoperation rate. There were no major differences between implants in wound infection, mortality or medical complications. Five trials (623 participants) compared the intramedullary hip screw (IMHS) with the SHS. Fracture fixation complications were more common in the IMHS group. Results for post-operative complications, mortality and functional outcomes were similar in both groups. Three trials (394 participants) showed no difference in fracture fixation complications, reoperation, wound infection and length of hospital stay for proximal femoral nail (PFN) versus the SHS. None of the 10 trials (1491 participants) of other nail versus extramedullary implant comparisons for trochanteric fractures provided sufficient evidence to establish definite differences between the implants under test. Two trials (65 participants) found intramedullary nails were associated with fewer fracture fixation complications than fixed nail plates for unstable fractures at the level of the lesser trochanter. Two trials (124 participants) found a tendency to less fracture healing complications with the intramedullary nails compared with fixed nail plates for subtrochanteric fractures.Keywords
This publication has 65 references indexed in Scilit:
- A Comparison of Proximal Femoral Nail Antirotation and Dynamic Hip Screw Devices in Trochanteric FracturesJournal of International Medical Research, 2009
- Functional comparison of the dynamic hip screw and the Gamma locking nail in trochanteric hip fractures: a matched-pair study of 268 patientsInternational Orthopaedics, 2007
- Trochanteric Gamma Nail and Compression Hip Screw for Trochanteric FracturesJournal of Orthopaedic Trauma, 2005
- A comparative prospective study of dynamic variable angle hip screw and Gamma nail in intertrochanteric hip fracturesDisability and Rehabilitation, 2005
- Welchen Einfluss hat das Implantat auf die perioperative Morbidität bei osteosynthetischer Versorgung pertrochantärer Femurfrakturen?Zeitschrift Fur Orthopadie Und Ihre Grenzgebiete, 2005
- Measuring inconsistency in meta-analysesBMJ, 2003
- A Randomized Study of the Compression Hip Screw and Gamma Nail in 426 FracturesClinical Orthopaedics and Related Research, 2002
- Pertrochanteric Fractures: Is There an Advantage to an Intramedullary Nail?Journal of Orthopaedic Trauma, 2002
- Dynamic Hip Screw With Trochanteric Stabilizing Plate in the Treatment of Unstable Proximal Femoral Fractures: A Comparative Study With the Gamma Nail and Compression Hip ScrewJournal of Orthopaedic Trauma, 1998
- A Prospective Comparative Study of the Compression Hip Screw and the Gamma NailJournal of Orthopaedic Trauma, 1994