Incidence of nonunion after surgery of distal femoral fractures using contemporary fixation device: a meta‐analysis
- 9 May 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in Archives of orthopaedic and trauma surgery
- Vol. 141 (2), 225-233
- https://doi.org/10.1007/s00402-020-03463-x
Abstract
Purpose Nonunion is the most frequent cause of reoperation and is associated with high morbidity after distal femur fracture (DFF). We examined the rates of nonunion requiring reoperation after fixation for DFF using a locking compression plate (LCP) or retrograde intramedullary nail (RIMN). Methods We included four studies comparing LCP and RIMN and 38 single-cohort studies reporting LCP or RIMN. In total, 2156 femurs were included and 166 non-unions were detected. We conducted a pair-wise meta-analysis (with a fixed-effects model) on the four comparative studies and a proportional meta-analysis on the 38 articles to estimate the nonunion rate. We performed sensitivity analysis by comparing studies using LCP with less invasive surgical systems (LISS) with those that used RIMN. Results The pairwise meta-analysis showed a similar nonunion rate between the groups [odds ratio: 1.02; 95% confidence interval (CI) 0.94–1.11, p = 0.633]. According to proportional meta-analysis, the pooled prevalence of nonunion was 5% (95% CI 4–7) totally, 6% (95% CI 4–8) in the LCP group, and 4% (95% CI 2–6) in the RIMN group (heterogeneity: p = 0.105). According to the sensitivity analysis, there was no difference in the union rate. The pooled prevalence of nonunion from sensitivity analysis was 4 % (95% CI, 3–5); it was 4% (95% CI, 3–6) in LCP with LISS and was 4% (95% CI, 2–6) in RIMN group (heterogeneity: p = 0.941). Conclusion Approximately 5% of patients who underwent LCP or RIMN fixation developed nonunion. Therefore, LCP and RIMN are effective DFF techniques and mastering one of them is essential.Keywords
This publication has 51 references indexed in Scilit:
- Low risk of nonunion with lateral locked plating of distal femoral fractures—A retrospective study of 191 consecutive patientsInjury, 2019
- Localization of Atypical Femoral Fracture on Straight and Bowed FemursJournal of Bone Metabolism, 2019
- Comparing Outcomes of Tumor Prosthesis Revision and Locking Plate Fixation in Supracondylar Femoral Periprosthetic FracturesClinics in Orthopedic Surgery, 2018
- Healing, nonunion, and re-operation after internal fixation of diaphyseal and distal femoral fractures: a systematic review and meta-analysisInternational Orthopaedics, 2018
- To Assess Functional Outcome for Intra-Articular and Extra-Articular Distal Femur Fracture in Patients using Retrograde Nailing or Locked Compression PlatingJournal of Clinical and Diagnostic Research, 2018
- Surgical Outcomes of Biologic Fixation for Subtrochanteric Fracture Using Locking Compression PlatesHip & Pelvis, 2017
- Retrograde Nailing versus Locked Plating of Extra-Articular Distal Femoral Fractures: Comparison of 36 CasesMedical Principles and Practice, 2012
- Outcome analysis of retrograde nailing and less invasive stabilization system in distal femoral fractures: A retrospective analysisIndian Journal of Orthopaedics, 2011
- 2010 Mid-America Orthopaedic Association Physician in Training Award: Healing Complications Are Common After Locked Plating for Distal Femur FracturesClinical Orthopaedics & Related Research, 2011
- Epidemiology of adult fractures: A reviewInjury, 2006