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Meta-Analysis
. 2023 Aug;143(8):5065-5083.
doi: 10.1007/s00402-023-04902-1. Epub 2023 May 2.

Extramedullary versus intramedullary fixation of stable trochanteric femoral fractures: a systematic review and meta-analysis

Miliaan L Zeelenberg #  1 , Leendert H T Nugteren #  1 , A Cornelis Plaisier  1 , Sverre A I Loggers  1   2 , Pieter Joosse  2 , Dennis Den Hartog  1 , Michael H J Verhofstad #  1 , Esther M M van Lieshout #  3 ; STABLE-HIP Study Group
Collaborators, Affiliations
Meta-Analysis

Extramedullary versus intramedullary fixation of stable trochanteric femoral fractures: a systematic review and meta-analysis

Miliaan L Zeelenberg et al. Arch Orthop Trauma Surg. 2023 Aug.

Abstract

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.

Keywords: AO type 31-A1; Extramedullary; Hip fracture; Intramedullary; Trochanteric.

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Conflict of interest statement

The authors have no competing interests to declare that are relevant to the content of this article.

Figures

Fig. 1
Fig. 1
Flowchart of search results, article inclusion and exclusion
Fig. 2
Fig. 2
Forrest plot for Harris hip score after extramedullary versus intramedullary fixation of stable trochanteric fractures. IV inverse variance, RCT randomized controlled trial, SD standard deviation
Fig. 3
Fig. 3
Forrest plot of 1-year pain score after extramedullary versus intramedullary fixation of stable trochanteric fractures
Fig. 4
Fig. 4
Forrest plot of reoperation rate after extramedullary versus intramedullary fixation of stable trochanteric fractures. M–H Mantel–Haenszel, RCT randomized controlled trial, SD standard deviation
Fig. 5
Fig. 5
Forrest plot of non-union rate after extramedullary versus intramedullary fixation of stable trochanteric fractures
Fig. 6
Fig. 6
Forrest plot of cut-out rate after extramedullary versus intramedullary fixation of stable trochanteric fractures
Fig. 7
Fig. 7
Forrest plot of peri-implant fracture rate after extramedullary versus intramedullary fixation of stable trochanteric fractures
Fig. 8
Fig. 8
Forrest plot of conversion to prosthesis rate after extramedullary versus intramedullary fixation of stable trochanteric fractures
Fig. 9
Fig. 9
Forrest plot of implant/fixation failure rate after extramedullary versus intramedullary fixation of stable trochanteric fractures
Fig. 10
Fig. 10
Forrest plot of mean operation time in minutes after extramedullary versus intramedullary fixation of stable trochanteric fractures
Fig. 11
Fig. 11
Forrest plot of mean blood loss in milliliters after extramedullary versus intramedullary fixation of stable trochanteric fractures
See this image and copyright information in PMC

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