Osteotomy, compression and other modifications of surgical techniques for internal fixation of extracapsular hip fractures

Hdl Handle:
http://hdl.handle.net/10149/95721
Title:
Osteotomy, compression and other modifications of surgical techniques for internal fixation of extracapsular hip fractures
Authors:
Parker, M. J. (Martyn); Handoll, H. H. G. (Helen)
Affiliation:
University of Teesside. Centre for Rehabilitation Sciences. Research Institute for Health Sciences and Social Care.
Citation:
Parker, M. J. and Handoll, H. H. G. (2009) 'Osteotomy, compression and other modifications of surgical techniques for internal fixation of extracapsular hip fractures', The Cochrane Database of Systematic Reviews, 2
Publisher:
Wiley-Blackwell
Journal:
The Cochrane Database of Systematic Reviews
Issue Date:
2009
URI:
http://hdl.handle.net/10149/95721
DOI:
10.1002/14651858.CD000522.pub2
Abstract:
Background: Many different surgical techniques have been described for the internal fixation of extracapsular hip fractures. Objectives: To compare different aspects of surgical technique used in operations for internal fixation of extracapsular hip fractures in adults. Search strategy: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (January 2008), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 1), MEDLINE, EMBASE, CINAHL, Current Controlled Trials, orthopaedic journals, conference proceedings and reference lists of articles. Date of last search was January 2008. No language restriction was applied. Selection criteria: All randomised and quasi-randomised trials investigating operative techniques used in operations for the treatment of extracapsular hip fractures in adults. Data collection and analysis: Two review authors independently selected trials, assessed trial quality and extracted data. Wherever appropriate, data were pooled. Main results: Predominantly older people with trochanteric fractures were treated in the 11 included trials. One trial (65 participants undergoing fixation with a fixed nail-plate) found no statistically significant differences between osteotomy versus anatomical reduction. Four trials, involving 465 participants undergoing fixation with a sliding hip screw (SHS), compared osteotomy versus anatomical reduction. Osteotomy was associated with an increased operative blood loss and length of surgery. There were no statistically significant differences for mortality, morbidity or measures of anatomical deformity. Two trials (138 participants) compared SHS fixation of a trochanteric hip fracture augmented with cement against a standard fixation. There were no reoperations even for the four cases of fixation failure in the cement group. The cement group had significantly better quality of life scores at six months. One trial (200 participants) comparing compression versus no compression of a trochanteric fracture in conjunctionwith SHS fixation found no significant differences between the two groups. One trial (120 participants) found a tendency to improved outcomes with a hydroxyapatite coated lag screw, but none reached statistical significance. One trial (19 participants) reported reduced temperatures when using a modified reaming method. Another trial (50 participants) found reduced bone marrow intravascular embolism, detected by oesophageal ultrasound, when a Gamma nail was inserted with a distal pressure venting hole in the femur. Authors' conclusions: There is inadequate evidence to support the use of osteotomy for internal fixation of a trochanteric hip fracture. Similarly, there is insufficient evidence to support the use of the other techniques examined in the trials included in this review.
Type:
Article
Language:
en
Keywords:
fracture fixation; internal; hip fractues; humans; osteotomy; randmized controlled trials
ISSN:
1469-493X
Rights:
In return for the grant of the licence, the author(s) shall have the following rights: The right to post the review as an electonic file on the author's own website and/or the author's institution's website, using the PDF version of the review available in the Cochrane Database of Systematic Reviews. [Advice from CEO of The Cochrane Collaboration]
Citation Count:
0 [Scopus, 06/04/2010]

Full metadata record

DC FieldValue Language
dc.contributor.authorParker, M. J. (Martyn)en
dc.contributor.authorHandoll, H. H. G. (Helen)en
dc.date.accessioned2010-04-06T14:46:06Z-
dc.date.available2010-04-06T14:46:06Z-
dc.date.issued2009-
dc.identifier.citationThe Cochrane Database of Systematic Reviews; 2en
dc.identifier.issn1469-493X-
dc.identifier.doi10.1002/14651858.CD000522.pub2-
dc.identifier.urihttp://hdl.handle.net/10149/95721-
dc.description.abstractBackground: Many different surgical techniques have been described for the internal fixation of extracapsular hip fractures. Objectives: To compare different aspects of surgical technique used in operations for internal fixation of extracapsular hip fractures in adults. Search strategy: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (January 2008), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 1), MEDLINE, EMBASE, CINAHL, Current Controlled Trials, orthopaedic journals, conference proceedings and reference lists of articles. Date of last search was January 2008. No language restriction was applied. Selection criteria: All randomised and quasi-randomised trials investigating operative techniques used in operations for the treatment of extracapsular hip fractures in adults. Data collection and analysis: Two review authors independently selected trials, assessed trial quality and extracted data. Wherever appropriate, data were pooled. Main results: Predominantly older people with trochanteric fractures were treated in the 11 included trials. One trial (65 participants undergoing fixation with a fixed nail-plate) found no statistically significant differences between osteotomy versus anatomical reduction. Four trials, involving 465 participants undergoing fixation with a sliding hip screw (SHS), compared osteotomy versus anatomical reduction. Osteotomy was associated with an increased operative blood loss and length of surgery. There were no statistically significant differences for mortality, morbidity or measures of anatomical deformity. Two trials (138 participants) compared SHS fixation of a trochanteric hip fracture augmented with cement against a standard fixation. There were no reoperations even for the four cases of fixation failure in the cement group. The cement group had significantly better quality of life scores at six months. One trial (200 participants) comparing compression versus no compression of a trochanteric fracture in conjunctionwith SHS fixation found no significant differences between the two groups. One trial (120 participants) found a tendency to improved outcomes with a hydroxyapatite coated lag screw, but none reached statistical significance. One trial (19 participants) reported reduced temperatures when using a modified reaming method. Another trial (50 participants) found reduced bone marrow intravascular embolism, detected by oesophageal ultrasound, when a Gamma nail was inserted with a distal pressure venting hole in the femur. Authors' conclusions: There is inadequate evidence to support the use of osteotomy for internal fixation of a trochanteric hip fracture. Similarly, there is insufficient evidence to support the use of the other techniques examined in the trials included in this review.en
dc.language.isoenen
dc.publisherWiley-Blackwellen
dc.rightsIn return for the grant of the licence, the author(s) shall have the following rights: The right to post the review as an electonic file on the author's own website and/or the author's institution's website, using the PDF version of the review available in the Cochrane Database of Systematic Reviews. [Advice from CEO of The Cochrane Collaboration]en
dc.subjectfracture fixationen
dc.subjectinternalen
dc.subjecthip fractuesen
dc.subjecthumansen
dc.subjectosteotomyen
dc.subjectrandmized controlled trialsen
dc.titleOsteotomy, compression and other modifications of surgical techniques for internal fixation of extracapsular hip fracturesen
dc.typeArticleen
dc.contributor.departmentUniversity of Teesside. Centre for Rehabilitation Sciences. Research Institute for Health Sciences and Social Care.en
dc.identifier.journalThe Cochrane Database of Systematic Reviewsen
ref.citationcount0 [Scopus, 06/04/2010]en
or.citation.harvardParker, M. J. and Handoll, H. H. G. (2009) 'Osteotomy, compression and other modifications of surgical techniques for internal fixation of extracapsular hip fractures', The Cochrane Database of Systematic Reviews, 2-
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