Two authors searched the articles independently using the following keywords: (1) reconstruction nail (2) hollow screw (3) femoral shaft and (4) femoral neck. The references from January 2010 to October 2018 were searched from PubMed, Springer, Embase, Wiley-Blackwell, and Chinese Journal Full-text Database. The comparison between reconstruction nail and hollow screw+plate was comprehensively analyzed. Therefore, a meta-analysis was conducted to evaluate the clinical efficacy and safety of these two methods comprehensively. Currently, only a few meta-analyses have compared the reconstruction nail and hollow screw+plate. Several articles have compared these two methods, encompassing various research designs, recruitment and exclusion criteria, and measurements. The main complications of femoral shaft combined with femoral neck fracture include nonunion of the femoral neck fracture, femoral head necrosis, coxa varus deformity, nonunion of the femoral shaft fracture, and malunion. However, the disadvantages of large trauma, excessive bleeding, extensive peeling of periosteum, and high probability of nonunion were reported. The advantages of the plate system in fixing the femoral shaft fracture and hollow nail in fixing the femoral neck fracture include simple operation, direct reduction, and control of the femoral shaft rotation. Meanwhile, the reconstruction nails have the following shortcomings: (a) great technical difficulty and the surgery should take into account both reduction and fixation, especially in the displacement of femoral neck fracture reduction and fixation operation and (b) femoral neck fractures can be shifted and rotated while placing a pin. Femoral reconstruction nail fixation has the following advantages: (a) fixation of the two fractures, axis fixation, and control of the length in multiple femoral shaft fractures and (b) closure of the pin, avoid damaging to local blood circulation, avoid peeling off the local periosteum, and minimal trauma.
In this study, the femoral reconstruction nail fixation, the plate system fixation, and the hollow nail fixation are discussed. If the hip is in the adduction position when it is injured, the posterior dislocation of the hip often occurs in addition to the fracture of the femoral head.Īlthough the treatment of the femoral neck with femoral shaft fracture is difficult, several methods have been reported. If the femoral shaft fracture cannot absorb all the energy, the residual force is transmitted to the femoral neck, resulting in femoral neck fracture. When the hip is in the flexion abduction position, and the knee is in the flexion position, the assault from the front and the inertia of the body result in an axial force. The femoral shaft and femoral neck fracture are mostly caused by trauma. The incidence of this injury accounts for about 10% of the total incidence of femoral shaft fractures. This meta-analysis shows that a reconstruction nail is a more efficient and safer treatment than a hollow screw+plate for patients with femoral shaft and femoral neck fracture.Ī femoral shaft combined with femoral neck fracture is a common condition. The meta-analysis suggested better characteristics for the reconstruction nail compared with the hollow screw+plate regarding operation time (OR = − 82.41, 95% CI, P < 0.00001 P for heterogeneity < 0.00001, I 2 = 98%), blood loss (OR = − 388.01, 95% CI, P < 0.00001 P for heterogeneity < 0.00001, I 2 = 99%), healing time of femoral shaft (MD = − 3.89, 95% CI, P < 0.00001 P for heterogeneity < 0.00001, I 2 = 99%), healing time of femoral neck (MD = − 4.04, 95% CI, P < 0.00001 P for heterogeneity = 0.008, I 2 = 60%), and complications (OR = 0.47, 95% CI, P = 0.0006 P for heterogeneity = 1.00, I 2 = 0%).
Finally, 10 studies met the eligibility criteria, including 991 patients. The meta-analysis was conducted with respect to the operation time, blood loss, healing time of the femoral shaft, healing time of the femoral neck, and complications. Review Manager 5.0 was adopted for meta-analysis, sensitivity analysis, and bias analysis.
FEMORAL NECK FRACTURE FULL
The full text of studies on clinical efficacy involving reconstruction nail and hollow screw+plate was retrieved from multiple databases. To compare the efficacy and complications between reconstruction nail and hollow screw+plate in patients with femoral shaft and femoral neck fracture.
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