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Titanium elastic nails vs locking plate in pediatric subtrochanteric femur fractures: A systematic review and
Yaqiang Zhang1, Yun Xue1, Maosheng Zhao1
1Department of Orthopedics, The 940th Hosptial of Joint Logistics Support Force of Chinese People's Liberation Army, Gansu, China.
Insights
Titanium elastic nails (TENs) offer faster healing and shorter hospital stays for pediatric subtrochanteric femur fractures compared to locking plates (LPs). However, TENs involve more fluoroscopy and a higher risk of certain deformities, while LPs reduce operator radiation exposure.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Trauma Management
Background:
- Subtrochanteric femur fractures in children are commonly treated with either titanium elastic nails (TENs) or locking plates (LPs).
- The optimal choice between TENs and LPs for internal fixation remains a subject of clinical debate.
Purpose of the Study:
- To systematically evaluate the effectiveness and safety of TENs versus LPs in treating pediatric subtrochanteric femur fractures.
- To provide evidence-based guidance for clinical decision-making in this patient population.
Main Methods:
- A comprehensive literature search was conducted across multiple databases (CNKI, PubMed, Cochrane, Embase, Web of Science) up to October 2022.
- Meta-analysis of 9 included studies involving 407 pediatric patients (210 with TENs, 197 with LPs) was performed using Stata14.0 software.
Main Results:
- TENs were associated with significantly shorter operative time, less intraoperative bleeding, faster fracture healing, and shorter hospital stays compared to LPs.
- Patients treated with TENs achieved full weight-bearing earlier, but experienced more intraoperative fluoroscopy and a higher overall complication rate, including postoperative angulation and rotation deformities.
- No significant differences were found in lower limb length discrepancy or Harris hip scores between the two fixation methods.
Conclusions:
- TENs demonstrate advantages in terms of reduced operative time, blood loss, and faster recovery, enabling earlier weight-bearing.
- LPs offer benefits by minimizing operator radiation exposure and reducing the incidence of specific postoperative deformities.
- Both TENs and LPs are considered effective internal fixation methods for pediatric subtrochanteric femur fractures, with distinct advantages and disadvantages influencing the choice of treatment.
Objective:
Titanium elastic nails (TENs) and locking plates (LPs) are currently the main internal fixation for treating pediatric subtrochanteric femur fractures, and the optimal choice of internal fixation is controversial. This study aimed to systematically evaluate the effectiveness and safety of TENs and LPs in treating subtrochanteric fractures in children to provide a theoretical basis and reference for clinical treatment.
Methods:
The literature related to TENs and LPs for treating subtrochanteric fractures in children was searched using the CNKI, PubMed, Cochrane, Embase, and Web of Science, and the search time frame was from the establishment of the database to October 2022. Two evaluators screened the literature according to the inclusion and exclusion criteria and extracted relevant data. Meta-analysis was performed using Stata14.0 software.
Results:
A total of 9 studies with 407 patients with subtrochanteric femur fractures were included in the final screening, including 210 cases with TENs and 197 cases with LPs. Meta-analysis results showed that compared with the locking plate, TEN had a shorter operative time [WMD = -1.3, 95%CI(-1.94,-0.66), p < 0.01], less intraoperative bleeding [WMD = -84.45, 95%CI(-111.09, -57.82), p < 0.01], shorter fracture healing time [WMD = -1.3, 95%CI(-1.94,-0.66), P < 0.01], shorter hospital stays [WMD = -2.80, 95% CI(-4.63,-0.98), p < 0.01], and earlier full weight bearing [SMD = -0.48, 95% CI(-0.91,-0.04), p < 0.05] but more intraoperative fluoroscopy [WMD = 28.23, 95% CI(15.22,41.25), p < 0.05]. The overall complication rate was high [OR = 3.52, 95% CI(1.96,6.34), p < 0.05], and the postoperative period was prone to angulation, rotation, and inversion deformity [OR = 3.68, 95% CI(1.40, 9.68), p < 0.05]. No significant difference in the incidence of lower limb inequality between the two types of internal fixation [OR = 0.83, 95% CI(0.38, 1.85), p > 0.05] and no significant difference in the Harris score of the hip at the last follow-up between the two types of internal fixation [WMD = -0.67, 95% CI(-2.01,0.67), p > 0.05] were found.
Conclusion:
In comparison to LPs, TENs have a shorter operation time, less intraoperative bleeding, and a shorter fracture healing time, and the child can be fully weight-bearing earlier. Locking plates can reduce the operator's x-ray exposure, and the incidence rate of postoperative angulation, rotation, and inversion deformity is low. Therefore, TENs and LPs are the best internal fixation methods for treating subtrochanteric fractures in children.
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