Purpose:To methodically assess the effectiveness of augmentative plating(AP)and exchange nailing(EN)in managing nonunion following intramedullary nailing for long bone fractures of the lower extremity.Methods:PubMed,E...Purpose:To methodically assess the effectiveness of augmentative plating(AP)and exchange nailing(EN)in managing nonunion following intramedullary nailing for long bone fractures of the lower extremity.Methods:PubMed,EMBASE,Web of Science,and the Cochrane Library were searched to gather clinical studies regarding the use of AP and EN techniques in the treatment of nonunion following intramedullary nailing of lower extremity long bones.The search was conducted up until May 2023.The original studies underwent an independent assessment of their quality,a process conducted utilizing the Newcastle-Ottawa scale.Data were retrieved from these studies,and meta-analysis was executed utilizing Review Manager 5.3.Results:This meta-analysis included 8 studies involving 661 participants,with 305 in the AP group and 356 in the EN group.The results of the meta-analysis demonstrated that the AP group exhibited a higher rate of union(odds ratio:8.61,95%confidence intervals(CI):4.1217.99,p<0.001),shorter union time(standardized mean difference(SMD):-1.08,95%CI:-1.79--0.37,p=0.003),reduced duration of the surgical procedure(SMD:-0.56,95%CI:-0.93--0.19,p=0.003),less bleeding(SMD:-1.5,95%CI:-2.81--0.18,p=0.03),and a lower incidence of complications(relative risk:-0.17,95%CI:-0.27--0.06,p=0.001).In the subgroup analysis,the time for union in the AP group in nonisthmal and isthmal nonunion of lower extremity long bones was shorter compared to the EN group(nonisthmal SMD:-1.94,95%CI:-3.28--0.61,p<0.001;isthmal SMD:-1.08,95%CI:-1.64--0.52,p=0.002).Conclusion:In the treatment of nonunion in diaphyseal fractures of the long bones in the lower extremity,the AP approach is superior to EN,both intraoperatively(with reduced duration of the surgical procedure and diminished blood loss)and postoperatively(with an elevated union rate,shorter union time,and lower incidence of complications).Specifically,in the management of nonunion of lower extremity long bones with non-isthmal and isthmal intramedullary nails,AP demonstrated shorter union time in comparison to EN.展开更多
Background Augmentation plating has been used successfully to treat hypertrophic non-union after nail fixation.This study compared the efficacy of augmentation plating and exchange plating for treating hypertrophic no...Background Augmentation plating has been used successfully to treat hypertrophic non-union after nail fixation.This study compared the efficacy of augmentation plating and exchange plating for treating hypertrophic non-union of femoral shaft fracture after intramedullary nail fixation.Methods A total of 12 patients received augmentation plating and 15 patients received exchange plating as treatment for femoral shaft hypertrophic non-union.The procedures were conducted at our medical centre between January 2005and January 2012.Clinical follow-up was conducted at 2 weeks,1 month and then monthly until union was achieved to compare union time,operation time,bleeding and complications between the two groups.Results All patients underwent follow-up examinations until fracture union was achieved.The average length of followup time after the second treatment was （18.37±3.28） months.The time needed for union was （4.17±0.94） months in the augmentation plating group and （5.33±1.72） months in the exchange plating group.The operation time was （90.00±17.58） minutes in the augmentation plating group and （160.00±25.35） minutes in the exchange plating group.The amount of blood loss during the operation was （270.00±43.32） ml in the augmentation plating group and （530.00±103.65） ml in the exchange plating group.Both groups showed significant difference （P 〈0.05） in their results.No complications were reported after the second operation.Conclusions Augmentation plating after nail fixation could remove local rotation instability,facilitate simple operation,create minimal damage and enable exercise for early functional recovery.Therefore,augmentation plating is excellent for treating hypertrophic non-union after nail fixation in femoral shaft fracture.展开更多
基金financial support was received for the research,authorship,and/or publication of this articlesupported by the Wings Up Plan of Tangdu Hospital.
文摘Purpose:To methodically assess the effectiveness of augmentative plating(AP)and exchange nailing(EN)in managing nonunion following intramedullary nailing for long bone fractures of the lower extremity.Methods:PubMed,EMBASE,Web of Science,and the Cochrane Library were searched to gather clinical studies regarding the use of AP and EN techniques in the treatment of nonunion following intramedullary nailing of lower extremity long bones.The search was conducted up until May 2023.The original studies underwent an independent assessment of their quality,a process conducted utilizing the Newcastle-Ottawa scale.Data were retrieved from these studies,and meta-analysis was executed utilizing Review Manager 5.3.Results:This meta-analysis included 8 studies involving 661 participants,with 305 in the AP group and 356 in the EN group.The results of the meta-analysis demonstrated that the AP group exhibited a higher rate of union(odds ratio:8.61,95%confidence intervals(CI):4.1217.99,p<0.001),shorter union time(standardized mean difference(SMD):-1.08,95%CI:-1.79--0.37,p=0.003),reduced duration of the surgical procedure(SMD:-0.56,95%CI:-0.93--0.19,p=0.003),less bleeding(SMD:-1.5,95%CI:-2.81--0.18,p=0.03),and a lower incidence of complications(relative risk:-0.17,95%CI:-0.27--0.06,p=0.001).In the subgroup analysis,the time for union in the AP group in nonisthmal and isthmal nonunion of lower extremity long bones was shorter compared to the EN group(nonisthmal SMD:-1.94,95%CI:-3.28--0.61,p<0.001;isthmal SMD:-1.08,95%CI:-1.64--0.52,p=0.002).Conclusion:In the treatment of nonunion in diaphyseal fractures of the long bones in the lower extremity,the AP approach is superior to EN,both intraoperatively(with reduced duration of the surgical procedure and diminished blood loss)and postoperatively(with an elevated union rate,shorter union time,and lower incidence of complications).Specifically,in the management of nonunion of lower extremity long bones with non-isthmal and isthmal intramedullary nails,AP demonstrated shorter union time in comparison to EN.
文摘Background Augmentation plating has been used successfully to treat hypertrophic non-union after nail fixation.This study compared the efficacy of augmentation plating and exchange plating for treating hypertrophic non-union of femoral shaft fracture after intramedullary nail fixation.Methods A total of 12 patients received augmentation plating and 15 patients received exchange plating as treatment for femoral shaft hypertrophic non-union.The procedures were conducted at our medical centre between January 2005and January 2012.Clinical follow-up was conducted at 2 weeks,1 month and then monthly until union was achieved to compare union time,operation time,bleeding and complications between the two groups.Results All patients underwent follow-up examinations until fracture union was achieved.The average length of followup time after the second treatment was （18.37±3.28） months.The time needed for union was （4.17±0.94） months in the augmentation plating group and （5.33±1.72） months in the exchange plating group.The operation time was （90.00±17.58） minutes in the augmentation plating group and （160.00±25.35） minutes in the exchange plating group.The amount of blood loss during the operation was （270.00±43.32） ml in the augmentation plating group and （530.00±103.65） ml in the exchange plating group.Both groups showed significant difference （P 〈0.05） in their results.No complications were reported after the second operation.Conclusions Augmentation plating after nail fixation could remove local rotation instability,facilitate simple operation,create minimal damage and enable exercise for early functional recovery.Therefore,augmentation plating is excellent for treating hypertrophic non-union after nail fixation in femoral shaft fracture.
