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Incidence of nonunion after surgery of distal femoral fractures using contemporary fixation device: a meta‐analysis

  • Trauma Surgery
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Abstract

Purpose

Nonunion is the most frequent cause of reoperation and is associated with high morbidity after distal femur fracture (DFF). We examined the rates of nonunion requiring reoperation after fixation for DFF using a locking compression plate (LCP) or retrograde intramedullary nail (RIMN).

Methods

We included four studies comparing LCP and RIMN and 38 single-cohort studies reporting LCP or RIMN. In total, 2156 femurs were included and 166 non-unions were detected. We conducted a pair-wise meta-analysis (with a fixed-effects model) on the four comparative studies and a proportional meta-analysis on the 38 articles to estimate the nonunion rate. We performed sensitivity analysis by comparing studies using LCP with less invasive surgical systems (LISS) with those that used RIMN.

Results

The pairwise meta-analysis showed a similar nonunion rate between the groups [odds ratio: 1.02; 95% confidence interval (CI) 0.94–1.11, p = 0.633]. According to proportional meta-analysis, the pooled prevalence of nonunion was 5% (95% CI 4–7) totally, 6% (95% CI 4–8) in the LCP group, and 4% (95% CI 2–6) in the RIMN group (heterogeneity: p = 0.105). According to the sensitivity analysis, there was no difference in the union rate. The pooled prevalence of nonunion from sensitivity analysis was 4 % (95% CI, 3–5); it was 4% (95% CI, 3–6) in LCP with LISS and was 4% (95% CI, 2–6) in RIMN group (heterogeneity: p = 0.941).

Conclusion

Approximately 5% of patients who underwent LCP or RIMN fixation developed nonunion. Therefore, LCP and RIMN are effective DFF techniques and mastering one of them is essential.

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Acknowledgements

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Funding

None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work.

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  1. Byung-Ho Yoon and In Keun Park equally contributed to this work, and should be considered co-first authors.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Inje University College of Medicine, Seoul Paik Hospital, Seoul, South Korea

    Byung-Ho Yoon & In Keun Park

  2. Department of Orthopedic Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea

    Youngwoo Kim

  3. Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea

    Hyoung-Keun Oh & Suk Kyu Choo

  4. Department of Orthopaedic Surgery, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, South Korea

    Yerl-Bo Sung

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Supplementary file1 Appendix A. The detailed search strategy for relevant clinical study selection (DOCX 19 kb)

402_2020_3463_MOESM2_ESM.docx

Supplementary file2 Appendix B. The quality assessment of each study according to the Newcastle-Ottawa Scales (DOCX 21 kb)

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Yoon, BH., Park, I.K., Kim, Y. et al. Incidence of nonunion after surgery of distal femoral fractures using contemporary fixation device: a meta‐analysis. Arch Orthop Trauma Surg 141, 225–233 (2021). https://doi.org/10.1007/s00402-020-03463-x

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