Antegrade vs Retrograde Intra-Medullary Nailing in Femoral Shaft Fractures: A Systematic Review and Meta-Analysis

Document Type : SYSTEMATIC REVIEW

Authors

1 Department of Orthopaedic Surgery, Brown University, Providence, Rhode Island, USA- Hotel Dieu de France, Orthopedics department, Beirut, Lebanon

2 Hotel Dieu de France, Orthopedics department, Beirut, Lebanon

3 Department of Orthopaedic Surgery, Brown University, Providence, Rhode Island, USA - Hotel Dieu de France, Orthopedics department, Beirut, Lebanon

4 Department of Orthopaedic Surgery, Lebanese American University Medical Center Rizk Hospital, Beirut, Lebanon

5 Division of Orthopaedic Surgery and Sports Medicine, University of Toronto, Toronto, Canada

Abstract

Objectives: Femoral shaft fractures are one of the most prevalent fractures found in clinical practice. Numerous operative and non-operative options are readily available for the treatment of such fractures with intra-medullary nailing being the gold standard. To date, no consensus has been reached favoring one approach over the other. Thus, this meta-analysis aims to compare the outcomes between an antegrade and retrograde intra-medullary nailing for the treatment of femoral shaft fractures.
Methods: PubMed, Cochrane, Google Scholar (page 1-20), and Embase were searched till January 2024. The clinical outcomes evaluated were the incidence of adverse events, reoperations, hip and knee pain, and surgery-related parameters.
Results: Higher rates of hip pain, and heterotopic ossification (p=0.0003, and p=0.0002 respectively) was observed with antegrade nailing. However, a higher rate of knee pain (p=0.02) was appreciated in retrograde nailing. There was no statistically significant difference in the remaining analyzed outcomes such as operative time, reoperation rate or other complications.
Conclusion: Despite a higher rate of heterotopic ossification using the antegrade nailing technique, both the antegrade and retrograde nailing techniques yield overall similar outcomes. Therefore, the decision to choose one or the other should be based on patient-related factors, and the surgeon’s experience and preference.
 Level of evidence: IV

Keywords

Main Subjects

References

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The Archives of Bone and Joint Surgery
Volume 12, Issue 8
August 2024
Pages 535-545

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History

  • Receive Date: 03 April 2024
  • Revise Date: 26 May 2024
  • Accept Date: 23 May 2024

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