Department of Surgery Clinical Research Unit, Westchester Medical Center Health Network, Valhalla, New York, USA.
Trauma Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar.
J Orthop Surg Res. 2018 Jun 28;13(1):160. doi: 10.1186/s13018-018-0856-4.
There is no consensus yet on the impact of timing of femur fracture (FF) internal fixation on the patient outcomes. This meta-analysis was conducted to evaluate the contemporary data in patients with traumatic FF undergoing intramedullary nail fixation (IMN).
English language literature was searched with publication limits set from 1994 to 2016 using PubMed, Scopus, MEDLINE (OVID), EMBASE (OVID), Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL). Studies included randomized controlled trials (RCTs), prospective observational or retrospective cohort studies, and case-control studies comparing early versus late femoral shaft fractures IMN fixation. Variable times were used across studies to distinguish between early and late IMN, but 24 h was the most frequently used cutoff. The quality assessment of the reviewed studies was performed with two instruments. Observational studies were assessed with the Newcastle-Ottawa Quality Assessment Scale. RCTs were assessed with the Cochrane Risk of Bias Tool.
We have searched 1151 references. Screening of titles and abstracts eliminated 1098 references. We retrieved 53 articles for full-text screening, 15 of which met study eligibility criteria.
This meta-analysis addresses the utility of IMN in patients with FF based on the current evidence; however, the modality and timing to intervene remain controversial. While we find large pooled effects in favor of early IMN, for reasons discussed, we have little confidence in the effect estimate. Moreover, the available data do not fill all the gaps in this regard; therefore, a tailored algorithm for management of FF would be of value especially in polytrauma patients.
股骨骨折（FF）内固定时机对患者预后的影响尚未达成共识。本荟萃分析旨在评估接受髓内钉固定（IMN）的创伤性 FF 患者的当代数据。
使用 PubMed、Scopus、MEDLINE（OVID）、EMBASE（OVID）、Web of Science 和 Cochrane 对照试验中心注册（CENTRAL）从 1994 年至 2016 年检索英文文献。纳入比较早期与晚期股骨骨干 IMN 固定的随机对照试验（RCT）、前瞻性观察性或回顾性队列研究以及病例对照研究。研究中使用了不同的时间来区分早期和晚期 IMN，但 24 小时是最常用的截止时间。使用两种工具对回顾研究的质量进行评估。观察性研究使用纽卡斯尔-渥太华质量评估量表进行评估。RCT 用 Cochrane 偏倚风险工具进行评估。
我们共检索到 1151 篇参考文献。通过标题和摘要筛选，排除了 1098 篇参考文献。我们对 53 篇文章进行了全文筛选，其中 15 篇符合研究纳入标准。
本荟萃分析根据当前证据探讨了 IMN 在 FF 患者中的应用价值；然而，干预的方式和时机仍存在争议。虽然我们发现早期 IMN 有较大的汇总效果，但由于讨论的原因，我们对效果估计的信心不大。此外，现有的数据并不能填补这方面的所有空白；因此，制定 FF 管理的定制算法将特别在多发伤患者中具有价值。
