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Journal of Orthopaedic Science

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01-11-2015 | Original Article

Comparison of tip apex distance and cut-out complications between helical blades and lag screws in intertrochanteric fractures among the elderly: a meta-analysis

Authors: Shuang Li, Shi-Min Chang, Wen-Xin Niu, Hui Ma

Published in: Journal of Orthopaedic Science | Issue 6/2015

Abstract

Purpose

To investigate whether helical blade implant systems have advantages in terms of tip apex distance (TAD) and cut-out rate in comparison to conventional lag screws for intertrochanteric fractures in a geriatric population.

Methods

Relevant articles were sourced from the MEDLINE, Embase, Ovid and Cochrane Library databases from inception through March 2015. All randomized controlled trials (RCTs) comparing outcomes between helical blade and lag screw implant systems were selected. Mean TAD values and reported cut-out complications were noted. Each author independently assessed the relevance of the enrolled studies and the quality of the extracted data. Data were analyzed using R software.

Results

Ten studies including 1831 patients were eligible for this review, seven of which were included in a combined analysis of dichotomous outcomes and five in a combined analysis of continuous outcomes. The results revealed that, compared with lag screw implantations, the use of helical blades led to a lower rate of cut-out complications (95 % CI: 0.28–0.96, P = 0.036). Patients who experienced cut-out complications had a significantly greater tip apex distance (95 % CI: 0.68–1.34, P < 0.001). However, the actual tip apex distances were similar between the screw group and blade group (95 % CI: −0.44–0.79, P = 0.58).

Conclusions

No difference in TAD values was found between blades and screws. In addition, the cut-out risk in the blade-design group was lower than that of the screw group. Therefore, TAD is not an accurate predictor of cut-out risk.

Lobo-Escolar A, Joven E, Iglesias D, Herrera A. Predictive factors for cutting-out in femoral intramedullary nailing. Injury. 2010;41(12):1312–6.CrossRefPubMed

Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am. 1995;77(7):1058–64.PubMed

Windolf M, Braunstein V, Dutoit C, Schwieger K. Is a helical shaped implant a superior alternative to the Dynamic Hip Screw for unstable femoral neck fractures? A biomechanical investigation. Clin Biomech. 2009;24(1):59–64.CrossRef

Lenich A, Bachmeier S, Prantl L, Nerlich M, Hammer J, Mayr E, Al-Munajjed AA, Füchtmeier B. Is the rotation of the femoral head a potential initiation for cutting out? A theoretical and experimental approach. BMC Musculoskelet Disord. 2011;22(12):79.CrossRef

Zou J, Xu Y, Yang H. A comparison of proximal femoral nail antirotation and dynamic hip screw devices in trochanteric fractures. J Int Med Res. 2009;37(4):1057–64.CrossRefPubMed

Lenich A, Vester H, Nerlich M, Mayr E, Stockle U, Füchtmeier B. Clinical comparison of the second and third generation of intramedullary devices for trochanteric fractures of the hip-Blade vs screw. Injury. 2010;41(12):1292–6.CrossRefPubMed

Xu YZ, Geng DC, Yang HL, Zhu GM, Wang XB. Comparative study of trochanteric fracture treated with the proximal femoral nail anti-rotation and the third generation of gamma nail. Injury. 2010;41(12):1234–8.CrossRef

Liu Y, Tao R, Liu F, Wang YH, Zhou ZY, Cao Y, Wang H. Mid-term outcomes after intramedullary fixation of intertrochanteric femoral fractures using the new proximal femoral nail antirotation (PFNA). Injury. 2010;41(8):810–7.CrossRefPubMed

Garg B, Marimuthu K, Kumar V, Malhotra R, Kotwal PP. Outcome of short proximal femoral nail antirotation and dynamic hip screw for fixation of unstable trochanteric fractures. A randomised prospective comparative trial. Hip Int. 2011;21(5):531–6.CrossRefPubMed

10.

Fitzpatrick DC, Sheerin DV, Wolf BR, Wuest TK. A randomized, prospective study comparing intertrochanteric hip fracture fixation with the dynamic hip screw and the dynamic helical hip system in a community practice. Iowa Orthop J. 2011;31:166–72.PubMedCentralPubMed

11.

Stern R, Lübbeke A, Suva D, Miozzari H, Hoffmeyer P. Prospective randomised study comparing screw versus helical blade in the treatment of low-energy trochanteric fractures. Int Orthop. 2011;35(12):1855–61.PubMedCentralCrossRefPubMed

12.

Vaquero J, Munoz J, Prat S, Ramirez C, Aguado HJ, Moreno E, Perez MD. Proximal Femoral Nail Antirotation versus Gamma3 nail for intramedullary nailing of unstable trochanteric fractures. A randomised comparative study. Injury. 2012;43(S2):S47–54.CrossRefPubMed

13.

Zhang S, Zhang K, Jia YF, Yu B, Feng W. InterTan nail versus Proximal Femoral Nail Antirotation-Asia in the treatment of unstable trochanteric fractures. Orthopedics. 2013;36(3):e288–94.CrossRefPubMed

14.

Yang YH, Wang YR, Jiang SD, Jiang LS. Proximal femoral nail antirotation and third-generation Gamma nail: which is a better device for the treatment of intertrochanteric fractures? Singapore Med J. 2013;54(8):446–50.CrossRefPubMed

15.

De Bruijn K, den Hartog D, Tuinebreijer W, Roukema G. Reliability of predictors for screw cutout in intertrochanteric hip fractures. J Bone Joint Surg Am. 2012;94(14):1266–72.CrossRefPubMed

16.

Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses (homepage on the internet). Ottawa Health Research Institute: Ottawa, c1996–2006 [updated 09 June 2007; cited 06 September 2007]. http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm.

17.

Rubio-Avila J, Madden K, Simunovic N, Bhandari M. Tip to apex distance in femoral intertrochanteric fractures: a systematic review. J Orthop Sci. 2013;18(4):592–8.CrossRefPubMed

18.

Xu YZ, Geng, Mao HQ, Zhu XS, Yang HL. A comparison of the proximal femoral nail antirotation device and dynamic hip screw in the treatment of unstable pertrochanteric fracture. J Int Med Res. 2010;38(4):1266–75.CrossRefPubMed

19.

Nishiura T, Nozawa M, Morio H. The new technique of precise insertion of lag screw in an operative treatment of trochanteric femoral fractures with a short intramedullary nail. Injury. 2009;40(10):1077–83.CrossRefPubMed

20.

Nikoloski AN, Osbrough AL, Yates PJ. Should the tip apex distance (TAD) rule be modified for the proximal nail antirotation (PFNA)? A retrospective study. J Orthop Surg Res. 2013;17(8):35.CrossRef

21.

Parker MJ, Handoll HH. Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults. Cochrane Database Syst Rev. 2010;(9):CD000093. doi:10.1002/14651858.CD000093.pub5.

22.

Huang X, Leung F, Liu M, Chen L, Xu Z, Xiang Z. Is helical blade superior to screw design in terms of cut-out rate for elderly trochanteric fractures? A meta-analysis of randomized controlled trials. Eur J Orthop Surg Traumatol. 2014;24(8):1461–8.CrossRefPubMed

23.

Mingo-Robinet J, Torres-Torres M, Martinez-Cervell C, Alonso JA, García-González S. Comparative study of the second and third generation of Gamma nail for trochanteric fractures: review of 218 cases. J Orthop Trauma. 2015;29(3):e85–90.CrossRefPubMed

24.

Goffin JM, Jenkins PJ, Ramaesh R, Pankaj P, Simpson AH. What is the relevance of the tip-apex distance as a predictor of lag screw cut-out? PLoS One. 2013;8(8):e71195.PubMedCentralCrossRefPubMed

25.

Goffin JM, Pankaj P, Simpson AH. The importance of lag screw position for the stabilization of trochanteric fractures with a sliding hip screw: a subject-specific finite element study. J Orthop Res. 2013;31(4):596–600.CrossRefPubMed

Title: Comparison of tip apex distance and cut-out complications between helical blades and lag screws in intertrochanteric fractures among the elderly: a meta-analysis
Authors: Shuang Li
Shi-Min Chang
Wen-Xin Niu
Hui Ma
Publication date: 01-11-2015
Publisher: Springer Japan
Published in: Journal of Orthopaedic Science / Issue 6/2015
Print ISSN: 0949-2658
Electronic ISSN: 1436-2023
DOI: https://doi.org/10.1007/s00776-015-0770-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Comparison of tip apex distance and cut-out complications between helical blades and lag screws in intertrochanteric fractures among the elderly: a meta-analysis

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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