Intervention Review

Intramedullary nails for extracapsular hip fractures in adults

  1. Martyn J Parker1,*,
  2. Helen HG Handoll2

Editorial Group: Cochrane Bone, Joint and Muscle Trauma Group

Published Online: 19 JUL 2006

Assessed as up-to-date: 28 JUN 2007

DOI: 10.1002/14651858.CD004961.pub3


How to Cite

Parker MJ, Handoll HHG. Intramedullary nails for extracapsular hip fractures in adults. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD004961. DOI: 10.1002/14651858.CD004961.pub3.

Author Information

  1. 1

    Peterborough and Stamford Hospitals NHS Foundation Trust, Orthopaedic Department, Peterborough, Cambridgeshire, UK

  2. 2

    University of Teesside, Centre for Rehabilitation Sciences (CRS), Research Institute for Health Sciences and Social Care, Middlesborough, Tees Valley, UK

*Martyn J Parker, Orthopaedic Department, Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough District Hospital, Thorpe Road, Peterborough, Cambridgeshire, PE3 6DA, UK. martyn.parker@pbh-tr.nhs.uk.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 19 JUL 2006

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Intramedullary nails may be used for the surgical fixation of extracapsular hip fractures in adults.

Objectives

To compare different types or design modifications of intramedullary nails used in the fixation of extracapsular hip fractures.

Search methods

We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (June 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2007, Issue 2), MEDLINE (1966 to June week 3 2007), EMBASE (1988 to 2007 Week 27), the UK National Research Register, Current Controlled Trials, orthopaedic journals, conference proceedings and reference lists of articles.

Selection criteria

All randomised or quasi-randomised trials comparing different types of intramedullary nails or modifications to the design of intramedullary nails in the treatment of extracapsular hip fractures in adults.

Data collection and analysis

Both authors independently assessed trial quality and extracted data. Additional information was sought from all trialists.

Main results

Nine studies, involving a total of 1290 predominantly female and older people with mainly unstable trochanteric fractures, were included. Allocation concealment was confirmed in only one trial.

Four studies (910 participants) compared the proximal femoral nail with the Gamma nail. There was no statistically significant difference between the two implants in operative fracture of the femur (1/455 versus 5/455; relative risk 0.33, 95% confidence interval 0.07 to 1.63) nor differences for fracture healing complications, reoperations, other post-operative complications, mortality or function.

Two studies (185 participants) found no notable differences between the ACE nail versus the Gamma nail. One study (34 participants, all under 50 years) found no difference between the Recon nail versus the long Gamma nail. One study (80 participants) found no differences between a gliding nail versus a standard Gamma nail. Another study (81 participants) found no difference between a dynamically versus a statically locked intramedullary hip screw.

Authors' conclusions

The limited evidence from the randomised trials undertaken to date is insufficient to determine whether there are important differences in outcome between different designs of intramedullary nails used in the internal fixation of extracapsular hip fractures. Given the evidence of superiority of the sliding hip screw compared with intramedullary nails for extracapsular hip fractures, further studies comparing different designs of intramedullary nails are not a priority. Any new design should be evaluated in a randomised comparison with the sliding hip screw.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Intramedullary nails for extracapsular hip fractures in adults

Fractures of the upper part of the thigh bone (femur) are termed hip or proximal femoral fractures. Roughly half of all hip fractures are 'extracapsular' in that they lie outside the hip joint capsule. These fractures may be surgically fixed using metal implants. One type of implant is the 'intramedullary nail'. This consists of a metal rod, which is usually inserted from the upper end of the femur into the inner cavity (medulla) of the femur bone and held in place with screws.

This review assessed the evidence from nine randomised controlled trials that compared different designs of these nails. Four trials compared the proximal femoral nail with the Gamma nail in 910 older adults. Two trials involving 185 older adults compared the ACE intramedullary nail with the Gamma nail. One trial compared the Recon nail with the Gamma nail in 34 younger adults, all under 51 years old, with high-energy fractures such as from road traffic accidents. For all three comparisons there appeared to be no important differences in outcome between the two nails under test. One trial of 80 older adults looked at the effects of changing the design of one of the screws, and another trial of 81 older adults looked at the effects of changing one of the interlocking holes. Both these studies had too few participants to see if these changes in nail design had an important effect.

So far, the limited evidence from randomised controlled trials has not shown any important differences between the different designs of nails under test.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

以骨髓內鋼釘治療成人囊外髖部骨折之成效

骨髓內鋼釘可以經由手術固定成人囊外髖部骨折。他們可由股骨頂端(頭髁方向)或由股骨底部(髁頭方向)放入。

目標

為了比較不同樣式或設計經修改的骨髓內鋼釘用在囊外髖部骨折之成效。

搜尋策略

我門搜尋了the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (March 2006), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2006), MEDLINE, EMBASE, the UK National Research Register, several orthopaedic journals, conference proceedings and reference lists of articles。

選擇標準

所有隨機或半隨機試驗,比較不同樣式或設計經修改的骨髓內鋼釘,用在治療成人囊外髖部骨折。

資料收集與分析

兩位作者獨立評估試驗品質及抽取的資料。額外的資訊則由所有參與試驗人員去搜尋。

主要結論

有6項試驗,收案對象為1071位多數為女性及老年人,且主要為不穩定性股骨轉子間骨折。有一試驗有分組隱匿,三個試驗沒有說明,其他兩個試驗沒有分組隱匿。有四項試驗,共有910位參與者比較proximal femoral nail 和Gamma nail。雖然放入Gamma nail有增加骨折處粉碎(破碎)的風險,不過在手術中造成的股骨骨折則沒有統計上的差異(1/455 versus 5/455; relative risk 0.33, 95% confidence interval 0.07 to 1.63)。在骨折癒合過程的併發症、再次手術及其他術後併發症也無顯著差異。匯集的資料顯示骨釘植入物間的死亡率(relative risk 1.08, 95% confidence interval 0.82 to 1.41)或結果的功能評估並無顯著差異。一組研究80位參與者比較的滑動骨釘與標準Gamma nail並無顯著差異。另一組研究81位參與者中發現dynamically 與statically 髖骨鎖定型骨髓內鋼釘並無差異。

作者結論

由當今最新的隨機試驗有限的證據,仍無法決定不同設計的骨髓內鋼釘,對囊外髖部骨折有明顯的差異。由於髖部滑動型螺釘被認為優於骨髓內鋼釘用於治療囊外髖部骨折,比較不同設計的骨髓內鋼釘就不需優先。任何新的設計,應經由隨機性試驗與髖部滑動型螺釘做比較。

翻譯人

本摘要由林口長庚醫院陳威志翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

比較不同設計的骨髓內鋼釘,在大腿骨上端固定囊外髖部骨折。股骨上部骨折,稱為髖部或股骨近端骨折。大約一半的髖部骨折是屬於囊外骨折,骨折是在關節囊外的位置,大部份此類的骨折會使用金屬植入物來做固定。有一型的金屬植入物是骨髓內鋼釘,它的組成是一支金屬桿狀物,植入的方式可能由股骨的上端或下端穿入(骨髓腔)內部,再佐以骨釘做為固定。此項回顧評估的證據是由隨機試驗方式比較不同設計方式的骨釘。有四項試驗共有910位參與者比較近端股骨骨釘與Gamma nail,兩種骨釘的術後結果之間並無明顯差異;比較的內容包括了術中植入鋼釘時造成的骨折,以及晚期合併症例如癒合過程的併發症。另外兩項試驗包括了161位參與者著眼於改變標準的鋼釘的設計;一個試驗是改變螺釘的設計;另一個試驗則是改變螺釘孔的設計。這兩項試驗皆因為參與者人數太少,以至於無法看出這些鋼釘的設計改變是否有重要的影響。至目前為止,隨機性試驗有限的證據並無法顯示不同設計鋼釘的在測試下有顯著不同。