Clinical outcomes following long versus short cephalomedullary devices for fixation of extracapsular hip fractures: a systematic review and meta-analysis

Gabriel Kai Yang Tan,Christoph Sheng Chong,Hamid Rahmatullah Bin Abd Razak

doi:10.1038/s41598-021-03210-1

Abstract

Although both long and short cephalomedullary devices (CMDs) are used in the treatment of extracapsular hip fractures, the advantages of either option are subject to debate. This study aims to evaluate the differences in clinical outcomes with long versus short CMDs for extracapsular hip fractures. Studies included must have included subjects with at least 1 year of follow-up and reported on at least one of the following outcomes: rate of reoperation; rate of peri-implant fracture; operating time; blood loss; complication rate; length of hospital stay; 1-year mortality. Only articles written in the English language were included in this study. A search was conducted across the databases of Medline, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), CINAHL and Scopus for articles published from the inception of the database to 1 November 2020. Included studies were assessed for their risk of bias using the Risk of Bias Tool (RoB2) and the risk-of-bias in non-randomized studies – of interventions (ROBINS-I) tool. A total of 8460 fractures from 16 studies were included in the analysis, with 3690 fixed with short, and 4770 fixed with long CMDs. A meta-analysis of the results revealed that short CMDs offer peri-operative advantages, while long CMDs could offer longer-term advantages. Limitations of this study include a lack of randomized control trials included in the analysis. In conclusion, when planning for the treatment of extracapsular hip fractures, a patient specific approach may be necessary to make a decision according to the individual risk profile of the patient.

Highlights

Hip fractures are known to be increasing in frequency globally due to an ageing and active global population, with annual incidences set to rise to 6.26 million by 20501
While it has been found that axial stiffness is greater in the use of short cephalomedullary device (CMD), the overall results show no significant differences between short or long CMDs and suggest that either option can be employed for fixation of unstable EHFs10,11
Both long and short CMDs are used in the treatment of extracapsular hip fractures (EHFs), the theoretical advantages of either option are subject to debate[12]

Summary

Introduction

Hip fractures are known to be increasing in frequency globally due to an ageing and active global population, with annual incidences set to rise to 6.26 million by 20501. There have been lower reported rates on the incidence of peri-implant fractures, possibly due to the full-length nail providing protection to the entire femoral shaft[16,17]. These differences have not affected long term outcomes in patients, with both groups showing no significant difference in reoperation rates, complication rates or 1-year mortality r ates[18,19]. This systematic review and meta-analysis of current literature aims to evaluate the differences in clinical outcomes with long versus short cephalomedullary devices (CMDs) for extracapsular hip fractures with the primary outcome being operative time and secondary outcomes being complications such as blood loss and peri-implant fractures

Objectives

Methods

Results

Conclusion