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Arjun Sivakumar Centre for Orthopaedic & Trauma Research, University of Adelaide, Adelaide, South Australia, Australia

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Suzanne Edwards Adelaide Health Technology Assessment, University of Adelaide, Adelaide, South Australia, Australia

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Stuart Millar Centre for Orthopaedic & Trauma Research, University of Adelaide, Adelaide, South Australia, Australia

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Dominic Thewlis Centre for Orthopaedic & Trauma Research, University of Adelaide, Adelaide, South Australia, Australia

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Mark Rickman Centre for Orthopaedic & Trauma Research, University of Adelaide, Adelaide, South Australia, Australia
Department of Orthopaedics & Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia

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Purpose

  • The purpose of this study was to investigate differences in aseptic reoperation rates between single or dual lag screw femoral nails,in the treatment of intertrochanteric fractures (ITF) in elderly patients.

Methods

  • Electronic databases were searched for RCTs and prospective cohort studies treating elderly ITF patients with a single or dual screw femoral nails. Data for aseptic reoperation rates between single screw, dual separated screw and dual integrated screw devices were pooled using a random-effects meta-analysis with 95% CIs. Pooled proportions were compared using a N-1 chi-squared test. Complications contributing to aseptic reoperation rates were extracted, and the contribution of cut-out and periprosthetic fracture as a proportion of reoperations was analysed using a negative binomial regression model.

Results

  • Forty-two (n  = 42) studies were evaluated, including 2795 patients treated with a single screw device, 1309 patients treated with a dual separated screw device and 303 patients treated with a dual integrated screw device. There was no significant difference in aseptic reoperation rates between single and dual lag screw femoral nails of both separated and integrated lag screw designs. Moreover, complications of cut-out and periprosthetic fracture as a proportion of reoperations did not differ significantly between devices.

Conclusion

  • The current evidence showed that aseptic reoperation rates were not significantly different between single and dual screw nails of a separated lag screw design. For dual integrated screw devices, due to insufficient evidence available, further high quality RCTs are required to allow for decisive comparisons with these newer devices.

Article Type:
Review Article
Category:
Trauma
DOI:
https://doi.org/10.1530/EOR-21-0067
Volume/Issue:
Volume 7: Issue 7
Open access
Marcel Niemann Charité – Universitätsmedizin Berlin, Center for Musculoskeletal Surgery, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany

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Ellen Otto Charité – Universitätsmedizin Berlin, Center for Musculoskeletal Surgery, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany

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Christian Eder Charité – Universitätsmedizin Berlin, Center for Musculoskeletal Surgery, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany

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Yasmin Youssef Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany

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Lutz Kaufner Charité – Universitätsmedizin Berlin, Department of Anesthesiology and Intensive Care Medicine, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany

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Sven Märdian Charité – Universitätsmedizin Berlin, Center for Musculoskeletal Surgery, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany

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-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients . Health Technology Assessment 2013 17 1 – 79 . ( https

Article Type:
Review Article
Category:
Trauma
DOI:
https://doi.org/10.1530/EOR-22-0054
Volume/Issue:
Volume 7: Issue 10
Open access