Efficacy of retrograde intramedullary femoral nailing and locking plates in the treatment of distal femoral fracture: a systematic review and meta analysis

Zhen Yang, Department of traumatic orthopedics, Shengli Oilfield Central Hospital, 31#, Jinan road, Dongying District, Dongying, Shandong Province, 257000, China

Wei Zhang, Department of anesthesiology, Dongying District People's Hospital, 333#, Jinan road, Dongying District, Dongying, Shandong Province, 257000, China

Peng Fu, Department of traumatic orthopedics, Shengli Oilfield Central Hospital, 31#, Jinan road, Dongying District, Dongying, Shandong Province, 257000, China

Xianfeng Meng, Department of traumatic orthopedics, Shengli Oilfield Central Hospital, 31#, Jinan road, Dongying District, Dongying, Shandong Province, 257000, China

Abstract
The preferred treatment for distal femoral fracture was surgical reduction and internal fixation. In recent years, retrograde intramedullary nails(RIN) and locking plates were the most popular internal fixation methods in clinical practice. The goal of this study was to review eligible studies and compare the efficacy of retrograde intramedullary femoral nailing (RIN) and locking plates for the treatment of distal femoral fracture. A systematic search of electronic databases (PubMed, Cochrane Library and Embase) was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline with no language limitation. Studies were included if they compared the results of retrograde intramedullary femoral nailing (RIN) and locking plates for distal femoral fracture in adults. Data on the study setting, blood loss, operative time, non-union, varus or valgus deformity＞5°, the excellent and good rate of knee society function score criteria. A quality assessment was performed using the Quality Index score. We included 10 studies, with a total of 240 patients in the RIN group and 230 in the locking plates group. The results found that after RIN and locking plates, no significant difference in changes of blood loss (MD: -69.55, 95% CI: − 265.98–126.89), operative time (MD: -30.23, 95% CI: − 70.97–10.51), non-union (OR: 0.99, 95% CI: 0.37–2.66), varus or valgus deformity＞5° (OR: 2.10, 95% CI: 0.93–4.74), the excellent and good rate of knee society function score criteria (OR: 1.41, 95% CI: 0.81–2.46). There was no significant difference in clinical efficacy between RIN and locking plates in treating distal femoral fracture. RIN has obvious biomechanical advantages over locking plates, but, the locking plate is better choice for the treatment of osteoporotic distal femoral fractures in the elderly. According to patient's age, bone condition, fracture types, surgeons should make individual treatment plans.

Keywords
Retrograde intramedullary femoral nail· Plate· Internal fixation· Distal femoral fracture · Meta-analysis

Cite this paper
Zhen Yang, Wei Zhang, Peng Fu, Xianfeng Meng, Efficacy of retrograde intramedullary femoral nailing and locking plates in the treatment of distal femoral fracture: a systematic review and meta analysis , SCIREA Journal of Clinical Medicine. Volume 7, Issue 4, August 2022 | PP. 267-282. 10.54647/cm32883

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