The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

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

Document Type : SYSTEMATIC REVIEW

Authors
Kamil M. Amer
Dominick V. Congiusta
Brendan Smith
Kunj Jain
M. Kareem Shaath
Robert L. DalCortivo
Irfan H. Ahmed
Michael M. Vosbikian
Rutgers New Jersey Medical School Department of Orthopaedics, Newark, USA
10.22038/abjs.2023.64311.3088
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.
 Level of evidence: II
Keywords
Fracture fixation
Hip fracture
Outcomes
Systematic review
Subjects
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  3. Melton LJ 3rd, Gabriel SE, Crowson CS, Tosteson AN, Johnell O, Kanis JA. Cost-equivalence of different osteoporotic fractures. Osteoporos Int. 2003; 14(5):383-388. doi: 10.1007/s00198-003-1385-4.
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  25. Park SR, Kang JS, Kim HS, Lee WH, Kim YH. Treatment of intertrochanteric fracture with the Gamma AP locking nail or by a compression hip screw--a randomised prospective trial. Int Orthop. 1998; 22(3):157-160. doi: 10.1007/s002640050231.

26.              Radford PJ, Needoff M, Webb JK. A prospective randomised comparison of the dynamic hip screw and the gamma locking nail. J Bone Joint Surg Br. 1993; 75(5):789-793. doi: 

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  2. Goldacre MJ, Roberts SE, Yeates D. Mortality after admission to hospital with fractured neck of femur: database study. BMJ. 2002; 325(7369):868-869. doi: 10.1136/bmj.325.7369.868.
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  4. Tosounidis TH, Castillo R, Kanakaris NK, Giannoudis PV. Common complications in hip fracture surgery: Tips/tricks and solutions to avoid them. Injury. 2015; 46 Suppl 5:S3-11. doi: 10.1016/j.injury.2015.08.006.
  5. Tsang ST, Aitken SA, Golay SK, Silverwood RK, Biant LC. When does hip fracture surgery fail? Injury. 2014; 45(7):1059-1065. doi: 10.1016/j.injury.2014.03.019.
  6. Ortman JM, Velkoff VA, Hogan H. An Aging Nation: The Older Population in the United States. ProQuest, Ann Arbor. 2014.
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  9. Swart E, Makhni EC, Macaulay W, Rosenwasser MP, Bozic KJ. Cost-effectiveness analysis of fixation options for intertrochanteric hip fractures. J Bone Joint Surg Am. 2014; 96(19):1612-1620. doi: 10.2106/JBJS.M.00603.
  10. Asif N, Ahmad S, Qureshi OA, Jilani LZ, Hamesh T, Jameel T. Unstable Intertrochanteric Fracture Fixation - Is Proximal Femoral Locked Compression Plate Better Than Dynamic Hip Screw. J Clin Diagn Res. 2016; 10(1):RC09-13. doi: 10.7860/JCDR/2016/11179.7084.
  11. Knobe M, Drescher W, Heussen N, Sellei RM, Pape HC. Is helical blade nailing superior to locked minimally invasive plating in unstable pertrochanteric fractures? Clin Orthop Relat Res. 2012; 470(8):2302-2312. doi: 10.1007/s11999-012-2268-9.
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  13. Chua IT, Rajamoney GN, Kwek EB. Cephalomedullary nail versus sliding hip screw for unstable intertrochanteric fractures in elderly patients. J Orthop Surg (Hong Kong). 2013; 21(3):308-312. doi: 10.1177/230949901302100309.
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  15. Ahrengart L, Törnkvist H, Fornander P, et al. A randomized study of the compression hip screw and Gamma nail in 426 fractures. Clin Orthop Relat Res. 2002 ;( 401):209-222. doi: 10.1097/00003086-200208000-00024.
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The Archives of Bone and Joint Surgery
Volume 11, Issue 10
October 2023
Pages 595-604

  • Receive Date 14 March 2022
  • Revise Date 30 September 2023
  • Accept Date 13 August 2023