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How the Choice of Osteosynthesis Affects the Complication Rate of Intercalary Allograft Reconstruction? A Systematic Review and Meta-analysis

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Abstract

Background

There is no clear consensus on the optimal type of fixation in intercalary allograft reconstruction. In this study, we aimed to compare the rate of most common complications following the plate and nail fixation of the intercalary allograft.

Materials and Methods

We searched PubMed, EMBASE, Web of Science, Scopus, and Cochrane Library. Studies in which the complication rate of the single bridging plate and intramedullary nail fixation was extractable were included. Studies that used extra procedures such as cementation and fibular vascular graft augmentation were excluded. The primary outcome was the fixation-specific rate of nonunion. Secondary outcomes were the fixation-specific rate of fracture, infection, and local recurrence.

Results

In total, 13 studies with 431 reconstructions (352 reconstructions in the plate group and 79 reconstructions in the intramedullary nailing group) were included in this study. In the plate fixation, the rate of nonunion, fracture, infection and local recurrence was 12%, 11%, 11%, and 3%, respectively. In the intramedullary nail fixation, the rate of nonunion, fracture, infection, and local recurrence was 37%, 5%, 4%, and 0%, respectively. The rate of nonunion was significantly higher in the intramedullary nail group (OR = 6.34; 95% CI 2.98–13.49, P < 0.001). The rate of fracture, infection, and local recurrence was not significantly different between the two fixation methods.

Conclusions

Intramedullary nail is associated with a significantly higher rate of nonunion. Since the rate of other complications was not significantly different between the two osteosynthesis types, plate fixation could be considered as a better type of fixation.

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Authors and Affiliations

  1. Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran

    Khodamorad Jamshidi, Mansour Bahardoust, Abolfazl Bagherifard & Alireza Mirzaei

  2. Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Mansour Bahardoust

  3. Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran

    Arman Karimi Behnagh

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  1. Khodamorad Jamshidi
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  2. Mansour Bahardoust
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  3. Arman Karimi Behnagh
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Contributions

KJ, Study design and supervision; MB, Data analysis; AKB, Data analysis; AB, Reviewing the manuscript critically; AM, Study design and drafting the manuscript.

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Correspondence to Alireza Mirzaei.

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Jamshidi, K., Bahardoust, M., Karimi Behnagh, A. et al. How the Choice of Osteosynthesis Affects the Complication Rate of Intercalary Allograft Reconstruction? A Systematic Review and Meta-analysis. JOIO 56, 547–558 (2022). https://doi.org/10.1007/s43465-021-00563-7

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  • DOI: https://doi.org/10.1007/s43465-021-00563-7

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