Efficacy of anterograde and retrograde intramedullary nails in the treatment of distal femoral extraarticular fracture: a meta-analysis

doi:10.12307/2021.282

Abstract

Abstract: OBJECTIVE: Currently, there is some controversy regarding the use of anterograde or retrograde intramedullary nails for extrararticular fractures of the distal femor. Therefore, this article systematically evaluated the difference in the efficacy and safety of anterograde and retrograde intramedullary nailing in the treatment of distal femoral extrararticular fractures.
METHODS: The databases, including PubMed, Web of Science, The Cochrane Library, EMbase, Sciencedirect, Scopus, China National Knowledge Infrastructure, Chinese BioMedical Literature System, Wanfang Data, VIP database for Chinese Technical Periodicals, and Google Scholar were searched through Internet to collect clinical randomized controlled trials of antegrade and retrograde intramedullary nails for distal femoral fractures in adults at home and abroad. The basic data included in the study including the Harris score at the time of discharge, bone nonunion, fracture healing time, knee pain, operation time, intraoperative blood loss, and heterotopic ossification of the hip joints were extracted. The quality evaluation and analysis were conducted using Cochrane Handbook. The results of the included study were meta-analyzed by RevMan 5.3 software.
RESULTS: Ten randomized controlled clinical trials were included, with a total of 757 fractures, including 370 cases in the retrograde intramedullary nail group and 387 cases in the antegrade intramedullary nail group. There were no statistically significant differences in operation time, intraoperative blood loss, fracture healing time, knee pain and heterotopic ossification of the hip joints between retrograde intramedullary nails and antegrade intramedullary nails (P > 0.05). At the time of discharge, the hip joints Harris score showed that the retrograde intramedullary nail group was superior to the antegrade intramedullary nail group (RR=1.22, 95% CI:1.04-1.45, P=0.02). The incidence of bone nonunion in retrograde intramedullary nail group was lower than that in antegrade intramedullary nail group (RR=0.37, 95% CI: 0.14-0.96, P=0.04).
CONCLUSION: Evidence from 10 existing randomized controlled trials shows that retrograde intramedullary nails to repair the distal femoral shaft extraarticular fractures are superior to antegrade intramedullary nails in terms of hip function recovery and fracture healing. Therefore, retrograde intramedullary nails have certain advantages in the treatment of the distal femoral fractures.

Key words: bone, distal femoral fracture, implant, retrograde intramedullary nail, anterograde intramedullary nail, randomized controlled trials, complication, meta-analysis

CLC Number:

Yuan Jiaqin, Luan Fujun, Chen Yangfan, Li Bo. Efficacy of anterograde and retrograde intramedullary nails in the treatment of distal femoral extraarticular fracture: a meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2021, 25(30): 4915-4920.

Figures/Tables 10

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