Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
Arch Orthop Trauma Surg. 2023 Oct;143(10):6229-6241. doi: 10.1007/s00402-023-04950-7. Epub 2023 Jul 5.
Fractures of the proximal femur accompanied by a fracture of the femoral shaft are relatively rare, with a reported prevalence between 1 and 12%. Multiple surgical options are available, consisting of treatment with a single implant or with double implants. Controversy exists about the optimal management. A systematic review and pooled analysis were performed to assess the most reliable treatment for bifocal femoral fractures of the femur.
A literature search was conducted on July 15, 2022. Selected studies were screened on title and abstract by two researchers independently, and full texts were read by both authors. Emphasis was put on adverse events such as postoperative infection, healing complications, malalignment, and functional outcome using either a single implant or double implants.
For the proximal femoral fractures, no significant difference could be confirmed for avascular necrosis of the femoral neck (5.1% for single implant and 3.8% for double implants), nonunion (6.4% for single implant and 7.8% for double implants), or varus malalignment (6.6% for single implant and 10.9% for double implants). This study also suggests that the number of implants is irrelevant for complications of the femoral shaft regarding the rates of postoperative infection and healing complications. Pooled rates of bone healing complications were 1.6-2.7-fold higher when patients were treated with a single implant, but statistical significance could not be confirmed. For hardware failure, revision surgery, leg length discrepancy, and functional outcome, no difference between the two groups was found either.
The pooled proportions of all postoperative complications had overlapping confidence intervals; thus, no inference about a statistically significant difference on the number of implants used for treating ipsilateral fractures of the femur can be made. Both treatment groups showed a similar functional outcome at the last moment of follow-up, with more than 75% of the patients reporting a good outcome.
股骨近端伴股骨干骨折较为少见，其发生率为 1%至 12%。有多种手术方法可供选择，包括使用单一植入物或双植入物治疗。对于这种双重股骨骨折的最佳治疗方法存在争议。本系统回顾和汇总分析旨在评估治疗双侧股骨骨折最可靠的方法。
于 2022 年 7 月 15 日进行文献检索。两名研究人员分别对标题和摘要进行筛选，然后由两名作者阅读全文。重点关注术后感染、愈合并发症、对线不良和功能结果等不良事件，比较使用单一植入物或双植入物的治疗效果。
对于股骨近端骨折，未发现使用单一植入物和双植入物在股骨颈缺血性坏死（分别为 5.1%和 3.8%）、骨不连（分别为 6.4%和 7.8%）或内翻对线不良（分别为 6.6%和 10.9%）方面有显著差异。本研究还表明，对于股骨干并发症，植入物的数量与术后感染和愈合并发症的发生率无关。使用单一植入物时，骨愈合并发症的发生率高出 1.6-2.7 倍，但未达到统计学意义。在硬件失败、翻修手术、肢体长度差异和功能结果方面，两组之间也没有差异。
所有术后并发症的汇总比例置信区间重叠；因此，不能推断使用不同数量的植入物治疗同侧股骨骨折的结果存在统计学显著差异。两组在最后一次随访时的功能结果相似，超过 75%的患者报告了良好的结果。
