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Meta-Analysis
. 2020 Jul 13;21(1):461.
doi: 10.1186/s12891-020-03444-6.

Distal locked versus unlocked intramedullary nailing for stable intertrochanteric fractures, a systematic review and meta-analysis

Yan-Hui Li  1 , Tiecheng Yu  2 , Wenjing Shao  3 , Yanwei Liu  2 , Dong Zhu  4 , Lei Tan  5
Affiliations
Meta-Analysis

Distal locked versus unlocked intramedullary nailing for stable intertrochanteric fractures, a systematic review and meta-analysis

Yan-Hui Li et al. BMC Musculoskelet Disord. .

Abstract

Background: Intramedullary nails have become the main treatment for intertrochanteric fractures. However, a distal locking procedure during nailing gradually raised controversy. In this study, a systematic review and meta-analysis of clinical trials was performed to summarize existing evidence, aiming to determine the safety and efficacy of distal locking or unlocking in the nailing of stable intertrochanteric fractures.

Methods: Appropriate articles were identified using the most common public databases, such as PubMed, Embase, the Cochrane Library, and Google Scholar from the inception of each database to April 2019, without restriction of language, publication date, and considering ongoing trials. Eligible studies were represented by randomized controlled trials or retrospective cohort studies, comparing distal locking and unlocking for the treatment of acute stable intertrochanteric fractures in adult patients. Information regarding methodological quality, patient demographics, and clinical outcomes were extracted independently by two reviewers. Subsequently, patients were divided into a locking and unlocking group.

Results: This study included 9 articles, comprising a total of 1978 patients with a similar baseline. The results showed that the unlocking group had a shorter operation time, less intraoperative bleeding, lower transfusion rate, and less thigh pain after the treatment of femoral intertrochanteric fracture when compared with the distal locking group. No significant differences were observed in safety-related outcomes, including mortality, infection rate, cutting out, loss of reduction, backing out of lag screws, cephalic screw breakage, nail breakage, and peri-implant fractures between the two groups. In addition, efficacy-related outcomes including nonunion, delayed healing rates, and the Harris functional score were not significantly different between the two groups.

Conclusions: Our pooled analysis demonstrated that distal unlocking of stable intertrochanteric fractures can shorten the operation time, reduce intraoperative bleeding, and reduce the blood transfusion rate. The use of locked or unlocked intramedullary nailing does not affect long-term outcomes regarding complications and function.

Keywords: Intertrochanteric fracture; Intramedullary nails; Locked intramedullary nailing; Meta-analysis; Outcomes; Unlocked intramedullary nailing.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study flow diagram
Fig. 2
Fig. 2
Summary of the risk of bias of each included randomized controlled trial
Fig. 3
Fig. 3
Comparison of the duration of operation, blood loss, patients transfused, and fluoroscopy time between the locking group and unlocking group. SD = standard deviation, IV = inverse variance, CI = confidence interval, and df = degrees of freedom
Fig. 4
Fig. 4
Comparison of peri-implant fractures between the locking group and the unlocking group. SD = standard deviation, IV = inverse variance, CI = confidence interval, and df = degrees of freedom
Fig. 5
Fig. 5
Comparison of mortality between the locking group and the unlocking group. SD = standard deviation, IV = inverse variance, CI = confidence interval, and df = degrees of freedom
See this image and copyright information in PMC

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