Tratamiento de las fracturas inestables intertrocantéricas. (Inglés)

Las complicaciones del implante relacionado con el tratamiento de las fracturas inestables intertrocantéricas: meta-análisis de la dinámica de tornillo-lámina frente a la del tornillo intramedular en los dispositivos del clavo.

Audige L, Hanson B, Swiontkowski MF.
AO Clinical Investigation and Documentation, AO ASIF Center, 7270 Davos Platz, Clavadelerstrasse, Switzerland. laurent.audige@ao-asif.ch

The choice between dynamic screw-intramedullary nail (DSIN) devices and dynamic screw-plate (DSP) devices for the fixation of unstable trochanteric fractures remains controversial. This study presents a meta-analysis of fixation failures in unstable trochanteric femoral fractures using DSP devices or DSIN devices. Two independent assessors selected randomised controlled trials using a range of electronic databases, as well as reference lists of selected articles. A study quality checklist was used. The occurrence of fixation failure, in particular cut-out, was the primary subject of analysis using descriptive statistics and random-effect meta-analyses. Seventeen trials were identified. Meta-analyses showed no significant difference in the frequency of implant-related complications between the two types of devices. Iatrogenic femoral fractures associated with the use of DSIN devices represent a rare, but persistent, risk. There was a tendency for less frequent cut-out with intramedullary devices compared with DSP devices.

Int Orthop. 2003;27(4):197-203. Epub 2003 May 07.