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Review
. 2023;11(10):595-604.
doi: 10.22038/ABJS.2023.64311.3088.

Cephalomedullary Nailing has a Higher Reoperation Rate Compared to Sliding Hip Screw Fixation in the Treatment of Intertrochanteric Femur Fractures: A Systematic Literature Review and Meta-analysis

Kamil M Amer, Dominick V Congiusta, Brendan Smith, Kunj Jain, M Kareem Shaath, Robert L Dalcortivo, Irfan H Ahmed, Michael M Vosbikian
Review

Cephalomedullary Nailing has a Higher Reoperation Rate Compared to Sliding Hip Screw Fixation in the Treatment of Intertrochanteric Femur Fractures: A Systematic Literature Review and Meta-analysis

Kamil M Amer et al. Arch Bone Jt Surg. 2023.

Abstract

Objectives: Intertrochanteric hip fractures are a common orthopaedic injury in the United States. Complications of surgical treatment include nonunion, lag screw cutout, implant failure, post-operative pain, risk of refracture or reoperation, and infection. The purpose of this study was to compare the rate of complications of sliding hip screw fixation (SHS) compared to cephalomedullary nailing (CMN) for the treatment of closed intertrochanteric femur fractures in adult patients.

Methods: PubMed, CINAHL, and Cochrane Library databases were searched for studies comparing SHS to CMN in the treatment of closed intertrochanteric femur fractures in adults. Data were compiled to observe the rate of nonunion, cutout failure, infection, refracture, perioperative blood loss, reoperation, postoperative pain, pulmonary embolism/deep venous thrombosis (DVT), length of hospital stay, and mortality.

Results: Seventeen studies were included comprising 1,500 patients treated with SHS and 1,890 patients treated with CMN. Treatment of intertrochanteric femur fractures with SHS demonstrated significantly fewer refractures and reoperations. There was no significant difference in other variables between SHS and CMN treated groups.

Conclusion: This meta-analysis shows that the only notable difference in outcomes is patients treated with CMN have a higher rate of refracture and reoperation. With new advances in the development of both CMNs and SHS, further studies will be required to see if these differences persist in the coming years.

Keywords: Fracture fixation; Hip fracture; Outcomes; Systematic review.

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Conflict of interest statement

Author Michael M. Vosbikian, M.D. receives honorarium for content authorship from the Journal of Bone and Joint Surgery and is an editorial board member for ePlasty. We otherwise have no other conflicts of interest to disclose.

Figures

Figure 1
Figure 1
PRISMA Diagram for Included Studies
Figure 2
Figure 2
Risk of Bias Summary for Included Studies. Green circles indicate low risk, red circles indicate high risk, and yellow circles indicate unclear risk
Figure 3
Figure 3
Risk Ratio of Post-operative Pain after SHS or CMN for Intertrochanteric Femur Fractures
Figure 4
Figure 4
Risk Ratio of Nonunion after SHS or CMN for Intertrochanteric Femur Fractures
Figure 5
Figure 5
Risk Ratio of Cutout Failure after SHS or CMN for Intertrochanteric Femur Fractures
Figure 6
Figure 6
Mean Difference of Perioperative Blood Loss after SHS or CMN for Intertrochanteric Femur Fractures
Figure 7
Figure 7
Risk Ratio of Mortality after SHS or CMN for Intertrochanteric Femur Fractures
Figure 8
Figure 8
Risk Ratio of Post-operative Infection after SHS or CMN for Intertrochanteric Femur Fractures
Figure 9
Figure 9
Risk Ratio of Pulmonary Embolism after SHS or CMN for Intertrochanteric Femur Fractures
Figure 10
Figure 10
Risk Ratio of Refracture after SHS or CMN for Intertrochanteric Femur Fractures
Figure 11
Figure 11
Risk Ratio of Reoperation after SHS or CMN for Intertrochanteric Femur Fractures
See this image and copyright information in PMC

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