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Implant-related complications in the treatment of unstable intertrochanteric fractures: meta-analysis of dynamic screw-plate versus dynamic screw-intramedullary nail devices

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Abstract

The choice between dynamic screw-intramedullary nail (DSIN) devices and dynamic screw-plate (DSP) devices for the fixation of unstable trochanteric fractures remains controversial. This study presents a meta-analysis of fixation failures in unstable trochanteric femoral fractures using DSP devices or DSIN devices. Two independent assessors selected randomised controlled trials using a range of electronic databases, as well as reference lists of selected articles. A study quality checklist was used. The occurrence of fixation failure, in particular cut-out, was the primary subject of analysis using descriptive statistics and random-effect meta-analyses. Seventeen trials were identified. Meta-analyses showed no significant difference in the frequency of implant-related complications between the two types of devices. Iatrogenic femoral fractures associated with the use of DSIN devices represent a rare, but persistent, risk. There was a tendency for less frequent cut-out with intramedullary devices compared with DSP devices.

Résumé

Le choix entre clou centro-médullaire avec vis dynamique et vis-plaque dynamique pour la fixation des fractures trochantériennes instables reste controversé. Cette étude présente une méta-analyse d'échecs de la fixation des fractures trochantériennes instables utilisant ces deux procédés. Deux observateurs indépendants ont selectioné des études cliniques randomisées utilisant plusieurs bases de données électroniques, aussi bien que les listes de référence des articles sélectionnés. Une liste de contrôle de la qualité de l'étude a été utilisée. L'événement d'échec de la fixation, en particulier la protrusion articulaire, était le sujet fondamental d'analyse. Dix-sept études cliniques randomisées ont été identifiées. La méta-analyse n'a montré aucune différence notable dans la fréquence des complications liées à l'implant entre les deux types de matériel. Les fractures fémorales iatrogène associées à l'usage de matériel centro-médullaire représentent un risque rare, mais persistant. Il y avait une tendance à des protrusions articulaires moins fréquents avec le système intramédullaire comparé avec les vis-plaque dynamiques.

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Audigé, L., Hanson, B. & Swiontkowski, M.F. Implant-related complications in the treatment of unstable intertrochanteric fractures: meta-analysis of dynamic screw-plate versus dynamic screw-intramedullary nail devices. International Orthopaedics (SICOT) 27, 197–203 (2003). https://doi.org/10.1007/s00264-003-0457-6

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