OBJECTIVE: To compare the efficacy of proximal femoral nail anti-rotation (PFNA) versus dynamic hip screw (DHS) in the treatment of trochanteric fractures in adults. METHODS: Reports of studies using randomized controlled trials (RCT) to compare PFNA with DHS in the management of intertrochanteric fractures were retrieved (up to December 5, 2011) from the Cochrane Library, MEDLINE, Elsevier, the Chinese Biomedical Database, Wanfang Data,and manually. Methodological quality of the trials was critically assessed, and relevant data were extracted. Statistical software Revman? 5.0 was used for data-analysis. RESULTS: Thirteen RCTs involving 958 cases were included in the Meta-analysis. The results showed that, compared with DHS, PFNA significantly decreased the duration of surgery [WMD = -21.38, 95%CI (-33.05,-9.26), P<0.05], intra-operative blood loss [WMD = -176.36, 95%CI (-232.20, -120.52), P<0.05], the rate of post-operative complication [RR=0.46, 95%CI (0.31, 0.70), P<0.05], the rate of post-operative fixation failure[RR=0.27, 95%CI(0.11,0.62), P<0.05]. CONCLUSION PFNA for intertrochanteric fractures is superior to DHS in regards to the mean duration of surgery, mean intra-operative blood loss, the rate of post-operative complication, and the rate of post-operative fixation failure. But there is not enough evidence to show any difference between PFNA and DHS in regards to the mean duration of hospital, the mean duration of fracture healing, the rate of post-operative fracture, the rate of post-operative coxa vara, the rate of postoperative superficial wound infection, the rate of other post-operative complications or the Harris score after surgery.
Blood Loss, Surgical ; statistics & numerical data ; Bone Nails ; Bone Screws ; China ; epidemiology ; Fracture Fixation, Internal ; methods ; Fracture Healing ; Hip Fractures ; surgery ; Humans ; Postoperative Complications ; epidemiology ; Randomized Controlled Trials as Topic

BACKGROUND: Plate fixation is the most commonly used technique for the treatment of shaft fractures of both forearm bones (SFBFBs). However, all fractures are difficult to treat with plate fixation because of soft tissue injuries, fracture patterns, or the patient's condition. The purpose of this study is to compare the functional results of plate fixation only and combined plate and intramedullary (IM) nail fixation in SFBFBs. METHODS: Fifty-nine cases of SFBFBs that were surgically treated from June 2007 to July 2012 were retrospectively reviewed. In this study, 47 cases that were followed up for more than 12 months were included. All SFBFBs were divided into two groups according to the methods used for internal fixation: plate fixation only (group A) and combined plate and IM nail fixation (group B). The fixation methods were determined intraoperatively. Plate fixation was considered as the first option in all cases, but combined plate and IM nail fixation was selected as the second option if it was difficult to be fixed with plate only. Groups A and B comprised of 31 and 16 cases, respectively. The functional results were evaluated by the Grace and Eversmann rating system and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. RESULTS: In groups A and B, a radiologic union was achieved in 30/31 and 14/16 cases and average union time was 11.1 and 17.8 weeks, respectively. According to the Grace and Eversmann rating system, group A had excellent results in 15 cases, good in 14, acceptable in one, and unacceptable in one. Group B had excellent results in three cases, good in nine, acceptable in two, and unacceptable in two. The average DASH score was 7.1 points (range, 0 to 19.2 points) in group A and 15.1 points (range, 0 to 29.6 points) in group B. Three cases of nonunion with unacceptable results achieved a bony union by additional procedures and the functional results of these cases improved to good or excellent. CONCLUSIONS: The functional results and the average union time were superior in group A than in group B. However, we think that combined fixation is a useful method for SFBFBs that cannot be treated with plate fixation only.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bone Nails/*statistics & numerical data ; Bone Plates/*statistics & numerical data ; Female ; Forearm/surgery ; Fracture Fixation, Intramedullary/adverse effects/*methods/*statistics & numerical data ; Humans ; Male ; Middle Aged ; Radius Fractures/epidemiology/*surgery ; Range of Motion, Articular/*physiology ; Retrospective Studies ; Treatment Outcome ; Ulna Fractures/epidemiology/*surgery ; Young Adult

BACKGROUND: Although closed reduction and percutaneous pinning is accepted as the treatment of choice for displaced supracondylar fracture of the humerus, there are some debates on the pinning techniques, period of immobilization, elbow range of motion (ROM) exercise, and perceptions on the restoration of elbow ROM. This study was to investigate the consensus and different perspectives on the treatment of supracondylar fractures of the humerus in children. METHODS: A questionnaire was designed for this study, which included the choice of pinning technique, methods of elbow motion, and perception on the restoration of elbow ROM. Seventy-six orthopedic surgeons agreed to participate in the study and survey was performed by a direct interview manner in the annual meetings of Korean Pediatric Orthopedic Association and Korean Society for Surgery of the Hand. There were 17 pediatric orthopedic surgeons, 48 hand surgeons, and 11 general orthopedic surgeons. RESULTS: Ninety-six percent of the orthopedic surgeons agreed that closed reduction and percutaneous pinning was the treatment of choice for the displaced supracondylar fracture of the humerus in children. They showed significant difference in the choice of pin entry (lateral vs. crossed pinning, p = 0.017) between the three groups of orthopedic surgeons, but no significant difference was found in the number of pins, all favoring 2 pins over 3 pins. Most of the orthopedic surgeons used a removable splint during the ROM exercise period. Hand surgeons and general orthopedic surgeons tended to be more concerned about elbow stiffness after supracondylar fracture than pediatric orthopedic surgeons, and favored gentle passive ROM exercise as elbow motion. Pediatric orthopedic surgeons most frequently adopted active ROM exercise as the elbow motion method. Pediatric orthopedic surgeons and general orthopedic surgeons acknowledged that the patient's age was the most contributing factor to the restoration of elbow motion, whereas hand surgeons acknowledged the amount of injury to be the most contributing factor. CONCLUSIONS: More investigation and communication will be needed to reach a consensus in treating pediatric supracondylar fractures of the humerus between the different subspecialties of orthopedic surgeons, which can minimize malpractice and avoid medicolegal issues.
Age Factors ; Attitude of Health Personnel ; Bone Nails ; Chi-Square Distribution ; Child ; Consensus ; Elbow Joint/physiology ; Exercise Therapy/*methods ; Fracture Fixation, Internal/*methods ; Humans ; Humeral Fractures/rehabilitation/*surgery ; Orthopedics ; Questionnaires ; *Range of Motion, Articular ; Splints ; Statistics, Nonparametric ; Time Factors

BACKGROUND: Although closed reduction and percutaneous pinning is accepted as the treatment of choice for displaced supracondylar fracture of the humerus, there are some debates on the pinning techniques, period of immobilization, elbow range of motion (ROM) exercise, and perceptions on the restoration of elbow ROM. This study was to investigate the consensus and different perspectives on the treatment of supracondylar fractures of the humerus in children. METHODS: A questionnaire was designed for this study, which included the choice of pinning technique, methods of elbow motion, and perception on the restoration of elbow ROM. Seventy-six orthopedic surgeons agreed to participate in the study and survey was performed by a direct interview manner in the annual meetings of Korean Pediatric Orthopedic Association and Korean Society for Surgery of the Hand. There were 17 pediatric orthopedic surgeons, 48 hand surgeons, and 11 general orthopedic surgeons. RESULTS: Ninety-six percent of the orthopedic surgeons agreed that closed reduction and percutaneous pinning was the treatment of choice for the displaced supracondylar fracture of the humerus in children. They showed significant difference in the choice of pin entry (lateral vs. crossed pinning, p = 0.017) between the three groups of orthopedic surgeons, but no significant difference was found in the number of pins, all favoring 2 pins over 3 pins. Most of the orthopedic surgeons used a removable splint during the ROM exercise period. Hand surgeons and general orthopedic surgeons tended to be more concerned about elbow stiffness after supracondylar fracture than pediatric orthopedic surgeons, and favored gentle passive ROM exercise as elbow motion. Pediatric orthopedic surgeons most frequently adopted active ROM exercise as the elbow motion method. Pediatric orthopedic surgeons and general orthopedic surgeons acknowledged that the patient's age was the most contributing factor to the restoration of elbow motion, whereas hand surgeons acknowledged the amount of injury to be the most contributing factor. CONCLUSIONS: More investigation and communication will be needed to reach a consensus in treating pediatric supracondylar fractures of the humerus between the different subspecialties of orthopedic surgeons, which can minimize malpractice and avoid medicolegal issues.
Age Factors ; Attitude of Health Personnel ; Bone Nails ; Chi-Square Distribution ; Child ; Consensus ; Elbow Joint/physiology ; Exercise Therapy/*methods ; Fracture Fixation, Internal/*methods ; Humans ; Humeral Fractures/rehabilitation/*surgery ; Orthopedics ; Questionnaires ; *Range of Motion, Articular ; Splints ; Statistics, Nonparametric ; Time Factors