Condylocephalic nails versus extramedullary implants for extracapsular hip fractures

Area of Science:

• Orthopedic surgery
• Biomedical engineering
• Trauma care

Background:

• Condylocephalic nails are intramedullary implants inserted from above the knee into the femoral canal.
• Examples include Ender and Harris nails, commonly used in hip fracture treatment.

Purpose of the Study:

• To compare the efficacy and safety of condylocephalic nails against alternative implants for adult extracapsular hip fractures.
• Investigated implants include extramedullary options like fixed nail plates and sliding hip screws, as well as other intramedullary nails.

Main Methods:

• A systematic review of randomized or quasi-randomized trials was conducted.
• Searches included the Cochrane Musculoskeletal Injuries Group trials register and Medline up to August 1999.
• Trial quality was independently assessed, and data were extracted and pooled where appropriate.

Main Results:

• Eleven trials were analyzed, primarily comparing Ender nails to fixed nail plates or sliding hip screws.
• Condylocephalic nails showed reduced deep wound sepsis but higher rates of re-operation, femur fracture, implant cut-out, and nail backing out.
• Complications included leg shortening, external rotation deformity, and increased knee pain, potentially impacting return to walking ability.

Conclusions:

• The intra-operative benefits of condylocephalic nails are overshadowed by increased fracture healing complications and adverse outcomes compared to extramedullary implants, especially sliding hip screws.
• The use of condylocephalic nails, particularly Ender nails, for trochanteric fractures is deemed inappropriate.