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Meta-analysis suggests that the electromagnetic technique is better than the free-hand method for the distal locking during intramedullary nailing procedures

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Abstract

Objectives

To evaluate the comparative effectiveness and accuracy of electromagnetic technique (EM) verses free-hand method (FH) for distal locking in intramedullary nailing procedure.

Material and methods

Relevant original studies were searched in Medline, Pubmed, Embase, China National Knowledge Infrastructure, and Cochrane Central Database (all through October 2015). Comparative studies providing sufficient data of interest were included in this meta-analysis. The Stata 11.0 was used to analyze all data.

Results

Eight studies involving 611 participants were included, with 305 in EM group and 306 in FH group. EM outperformed FH with reduced distal locking time of 4.1 minutes [standardized mean difference (SMD), 1.61; 95 % confidence interval (95 %CI), 0.81 to 2.41] and the reduced fluoroscopy time of 25.3 seconds (SMD, 2.64; 95 %CI, 2.12 to 3.16). Regarding the accuracy of distal screw placement, no significant difference was observed between two techniques (OR, 2.39; 95 %CI, 0.38 to 15.0). There was a trend of longer operative time in FH versus EM by 10 minutes (79.0 and 69.0 minutes), although the difference was not statistically significant (SMD, 0.341; 95 % CI, -0.02 to 0.703).

Conclusions

The existing evidence suggests EM technique is a better alternative for distal locking in intramedullary nailing procedure, and this might aid in the management of diaphyseal fractures in lower extremities.

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Acknowledgments

We are grateful to Y Li and B Zhang of the Department of Orthopedics, and to X Zhang and Q Zhang of the Department of statistics and applications for their kind assistance.

Authors’ contributions

Yingze Zhang designed the study; Hengrui Chang and Yiyang Yu searched relevant studies and abstracted the data; Wei Chen and Song Liu analyzed and interpreted the data; Yanbin Zhu and Hengrui Chang wrote the manuscript and Yingze Zhang approved the final version of the manuscript.

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    Authors and Affiliations

    1. Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, Hebei, 050051, People’s Republic of China

      Yanbin Zhu, Hengrui Chang, Yiyang Yu, Wei Chen, Song Liu & Yingze Zhang

    2. Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People’s Republic of China

      Yanbin Zhu, Hengrui Chang, Yiyang Yu, Wei Chen, Song Liu & Yingze Zhang

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    1. Yanbin Zhu
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    Correspondence to Yingze Zhang.

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    Funding support

    This study was supported by the National Natural Science Foundation of China (Grant No. 81401789).

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    Yanbin Zhu and Hengrui Chang contributed equally to this work.

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    Zhu, Y., Chang, H., Yu, Y. et al. Meta-analysis suggests that the electromagnetic technique is better than the free-hand method for the distal locking during intramedullary nailing procedures. International Orthopaedics (SICOT) 41, 1041–1048 (2017). https://doi.org/10.1007/s00264-016-3230-3

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    • DOI: https://doi.org/10.1007/s00264-016-3230-3

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