Meta-analysis of flexible intramedullary nailing and external fixation for pediatric femoral shaft fractures

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1 Chinese Journal of Tissue Engineering Research July 23, 2015 Vol.19, No.31 Meta ( ) 1 2 Meta 3 Meta Meta (131PPTGG409-25) PubMedEmbaseMedlineCochrane Jadad Stata 12.0 Meta Meta, [RR=0.3095%CI P < 0.001][RR= %CI P=0.001] [RR=1.8695%CI P < 0.001] :R318 :B : (2015) Meta [J] (31): doi: /j.issn Meta-analysis of flexible intramedullary Guo Yong-cheng 1, Xing Guang-wei 1, Xia Bing 1, Feng Guo-ming 1, Dong Yan-zhao 1, Niu Xue-qiang 1, He Qian-yi 2 ( 1 Department of Orthopedics, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou , Henan Province, China; 2 Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou , Henan Province, China) Abstract BACKGROUND: Flexible intramedullary are two common methods in the clinic. It remains controversial which fixation methods are better. OBJECTIVE: To systematically evaluate the therapeutic effects of flexible intramedullary nailing and external fixation for pediatric. METHODS: A computer-based search was performed on PubMed, Embase, Medline, and Cochrane library for literatures on clinical controlled trials of flexible intramedullary femoral shaft fractures published before November 25, Literature language was not limited. The age of subjects was from 3 to 15 years. Modified Jadad was utilized to assess methodological quality of the included studies. Guo Yong-cheng, Master, Chief physician, Professor, Master s supervisor, Department of Orthopedics, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou , Henan Province, China Corresponding author: Xia Bing, Attending physician, Department of Orthopedics, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou , Henan Province, China Accepted: P.O. Box 10002, Shenyang

2 . Meta Meta-analysis was carried out using Stata 12.0 software. RESULTS AND CONCLUSION: Six papers involving 237 patients were included. Meta-analysis results showed that compared with external fixation, a low incidence of overall complications [relative risk (RR)=0.30, 95% confidence interval (CI): ; P < 0.001] and pin-hole infection (RR=0.286, 95%CI: ; P= 0.001), but a high risk of needle tail irritation (RR=1.86, 95%CI: ; P < 0.001) were found following flexible intramedullary nailing. No significant differences in other complications were found between the two groups. These results confirm that compared with external fixation, elastic intramedullary nail has fewer complications and faster fracture healing. Elastic intramedullary nail is recommended for single pediatric. However, external fixation is a better option for high energy injury of lower limbs, multiple trauma or severely soft tissue injury. Subject headings: Femur; Fractures, Bone; Bone Nails; Postoperative Complications; Meta-Analysis; Evidence-Based Medicine Funding: the Zhengzhou Science and Technology Project, No. 131PPTGG Guo YC, Xing GW, Xia B, Feng GM, Dong YZ, Niu XQ, He QY. Meta-analysis of flexible intramedullary nailing and external fixation for pediatric. Zhongguo Zuzhi Gongcheng Yanjiu. 2015;19(31): Introduction 1.6% [1] [2-4] PubMedEmbase 1.3 > 1 cm 1.4 2() 3() Jadad [5] 1.5 Stata 12.0(StataCorporation TexasUSA) (relative riskrr)95%(ci) (P > 0.05I 2 < 50%) (P < 0.05I 2 > 50%) α=0.05 Begg 1Data and methods 1.1 PubMedEmbaseMedline Cochrane Flexible/Elastic Intramedullary Nailingor Elastic nailing External Fixation Pediatric or Children Femoral Shaft Fractures Winquist GustiloABC 2Results (n=237) [6-11] 1 Jadad (P=0.992I 2 =0%) (RR=0.3095%CI P < 0.001) [7] Meta [6-11] (RR= %CI P= ) [611] (RR=1.8695%CI P < ) ISSN CN /R CODEN: ZLKHAH 5073

3 . Meta 1 Meta Jadad Table 1 Basic conditions and modified Jadad scores of the included meta-analysis studies () (/n) () Jadad FIN EF FIN EF FIN EF Ortiz-Espada [6] 2008 Spain /7 11/ Kim [7] 2008 Korea / Baron [8] 1997 British NA 14 7 Barlas [9] 2006 British NA 6 Park [10] 2008 Korea NA Wu [11] 2011 China ± ±2.3 23/13 19/12 12±3 5 FIN EF Jadad 6 (Jadad > 4 ) 1 Figure 1 Forest plot of the incidence of overall complications following flexible intramedullary 2 Figure 2 Forest plot of the incidence of pin-hole infection following flexible intramedullary nailing and external fixation for pediatric 3 Figure 3 Forest plot of the incidence of needle tail irritation following flexible intramedullary 5074 P.O. Box 10002, Shenyang

4 . Meta 4 Figure 4 Forest plot of the failure rate of internal fixation following flexible intramedullary 5 Figure 5 Forest plot of the incidence of refracture following flexible intramedullary 6 Figure 6 Forest plot of the incidence of foot drop following flexible intramedullary nailing and external fixation for pediatric femoral shaft fractures 7 Figure 7 Forest plot of the incidence of rotation deformity following flexible intramedullary nailing and external fixation for pediatric ISSN CN /R CODEN: ZLKHAH 5075

5 Meta 2 Meta Table 2 Meta-analysis results of secondary outcomes between the flexible intramedullary nailing and external fixation groups of the included studies OR(95%CI) P (> 1 cm) [8-9] 2 60 P=0.819I 2 =0% 0.38( ) [11] ( ) [8-9] P=0.989I 2 =0% 0.48( ) [(> 1 cm)] Meta Se(logRR) Se(logRR) RR RR 8 Begg Figure 8 Begg funnel plot of the incidence of overall complications and pin-hole infection following flexible intramedullary nailing and external fixation for pediatric AB Begg [ ] [6-11] [68-9] ( 47) Meta (> 1 cm) [8-911] 2.4 Begg 8 Begg 3Discussion [12-14] [15] [16-18] BO [19] AO [20-24] 5076 P.O. Box 10002, Shenyang

6 . Meta [25-29] Nascimento [30] d Nisar [31] %Lascombes [32] [33-36] Wani [37] 45 47%Aronson [38] 44 10%5.8 mmkong [39] 289 EI Hayek [40] Meta 0.5 cm 0.5 cm (ABC 3) BO AO 4 References [1].:SCI [J].,2012,16(30): [2] Huber H,André G,Rumeau F,et al.flexibleintramedullary nailingfor distalfemoral fracturesin patients with myopathies.j Child Orthop. 2012;6(2): [3] Wani MM,Dar RA,Latoo IA,et al.externalfixationof pediatricfemoralshaftfractures: a consecutive study based on 45fractures.J Pediatr Orthop B. 2013;22(6): [4] Nascimento FP, Santili C, Akkari M, et al. Short hospitalization period with elastic stable intramedullary nails in the treatment of in school children. J Child Orthop. 2010;4: [5] Jadad RA, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trails. 1996;17:1-12. [6] Ortiz-Espada A. Elastic nailing vs. external fixation as methods to address pediatric femoral fractures: a review of 40 cases.j Trauma. 2009;53(2): [7] Kim DY, Shin SR, Jeong US, et al. Comparison of Flexible Intramedullary Nailing with External Fixation in Pediatric Femoral Shaft Fractures. J Korean Orthop Soc. 2008; 43(1): [8] Baron E, Sagiv S, Porat S. External fixation or flexible intramedullary nailing for in children. J Bone Joint Surg Br. 1997;79-B(6): [9] Barlas K, Beg H. Flexible intramedullary nailing versus external fixation of paediatric femoral fractures.acta Orthop Belg. 2006;72(2): [10] Park SS, Park JB. Comparison of Flexible Intramedullary Nailing with External Fixation for Treating Pediatric Femoral Shaft Fractures.J Korean Orthop Soc.2008; 43(6): [11] Wu QZ,Zhang J,Lan SH.Clinical outcomes of elastic intramedullary nail fixation and external fixation for the treatment of pediatric.zhongguo Gu Shang. 2011;24(2): [12],,,. 32:[J]., 2010,14(17): [13] Leu D, Sargent MC, Ain MC, et al. Spica casting for pediatric femoral fractures: a prospective, randomized controlled study of single-leg versus double-leg spica casts. J Bone Joint Surg Am. 2012;94: ISSN CN /R CODEN: ZLKHAH 5077

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