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  • Author: Markus Siegel x
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Andreas Frodl Department of Orthopedics and Traumatology, Freiburg University Hospital, Freiburg, Germany

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Johannes Hauss Department of Orthopedics and Traumatology, Freiburg University Hospital, Freiburg, Germany

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Andreas Fuchs Department of Orthopedics and Traumatology, Freiburg University Hospital, Freiburg, Germany

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Markus Siegel Department of Orthopedics and Traumatology, Freiburg University Hospital, Freiburg, Germany

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Hagen Schmal Department of Orthopedic Surgery, University Hospital Odense, Odense, Denmark

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Jan Kühle Department of Orthopedics and Traumatology, Freiburg University Hospital, Freiburg, Germany

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Purpose

  • The fixation method of distal, extra-articular femur fractures is a controversially discussed. To ensure better stability itself, earlier mobilization and to prevent blood loss – all these are justifications for addressing the femur via reamed intramedullary nailing (RIMN). Anatomical reposition of multifragmentary fractures followed by increased risks of non-union are compelling reasons against it. The purpose of this study was to systematically review the literature for rates of non-union and wound infection, as well as blood loss and time of surgery.

Methods

  • According to the PRISMA guidelines we conducted this systematic review by searching the Cochrane, PubMed, Ovid, MedLine, and Embase databases. Inclusion criteria were the modified Coleman methodology score (mCMS) >60, age >18 years, and extra-articular fractures of the distal femur. Biomechanical and animal studies were excluded. By referring to title and abstract relevant articles were reviewed independently. In the consecutive meta-analysis, we compared 9 studies and 639 patients.

Results

  • There is no statistically significant difference comparing superficial wound infections when RIMN was performed (OR = 0.50; 95% CI: 0.18 – 1.42; P = 0.19) as well as in deep wound infections (OR = 0.74; 95% CI: 0.19–2.81; P = 0.62). However, these results were not significant. We also calculated for potential differences in the rate of non-unions depending on the surgical treatment applied. Data of 556 patients revealed an overall number of 43 non-unions. There was no significant difference in rate of non-unions between both groups (OR = 0.97; 95% CI: 0.51–1.85; P = 0.92).

Conclusion

  • No statistical difference was found in our study among RIMN and plate fixation in the treatment of distal femoral fractures with regard to the incidence of non-union and wound infections. Therefore, the indication for RIMN or plating should be made individually and based on the surgeon’s experience.

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