Distal Femoral Fractures In Adult Patients Treated With GSH And DCS:a Meta-analysis

Objective To evaluate the effect of the retrograde intramedullary nail(GSH)and the Dynamic Condylar Screw(DCS) for distal femoral fractures.Methods We searched Pubmed (1980-2013), Embase (1980-2013), Ovid(1993-2013), The Cochrane Library(Issue4,2013), CBMdisc(1980-2013),CNKI(1980-2013), VIP (1980-2013) and Wan fang Database(1980-2013)byelectronic database to collect cohort and case-control studies of comparing GSHwith DCS for distal femoral fractures. The quality of included studies were assessedaccording to the criteria recommended by the Cochrane Handbook for SystematicReviews of Interventions and data were extracted by two reviewers independently.We made meta-analysis, quantitative qualitative comprehensive analysis, funnel plotanalysis for the results of studies. In this meta-analysis, fixed or random potencymodel was chosen according to the heterogeneity. Meta analysis was conducted byThe Cochrane Collaboration’s RevMan5.2software. Estimated the evaluation indexby95%confidence interval and made α=0.05for the size of test.Results (1)Kolment Score:6study participants included361cases, includingretrograde interlocking intramedullary nail in185cases,176cases of dynamiccondylar screw. GSH and DCS difference was statisticallysignificant(P=0.02).(2)Rate of postoperative pain:4studies in266cases, DCS group136examples, GSH group130examples. Rate of knee pain similar between the twogroups have statistical significance(P=0.006).(3)gonyectyposis:8Study participantsincluded488cases, DCS group235examples, GSH group253examples. Cannotthink of two groups the incidence of postoperative knee varus difference was statistically significant (P=0.07).(4)infection:5participants included302cases,DCS group154examples, GSH group148examples. Cannot think the incidence ofpostoperative infection of similar between the two groups was statisticallysignificant (P=0.11).(5)bone ununion:8Study participants included588cases, DCSgroup297examples, GSH group291examples. Still can’t believe two groups ofpostoperative bone nonunion rate difference was statistically significant (P=0.21).(6)The knee joint stiffness:5Study participants included336cases, DCS group165examples, GSH group171examples. Still can’t believe the incidence ofpostoperative knee joint stiffness of similar between the two groups was statisticallysignificant (P=0.80).(7)hospital stays:4studies in214cases, DCS group99examples, GSH group115examples. Results show that the two groups in hospitaltime difference was statistically significant (P <0.00001).(8)drainage volume:2Study participants included112patients, DCS group of53cases,59cases of GSHgroup. Results show that the two groups had the flow difference was statisticallysignificant (P <0.00001).Conclusion Comparison with GSH group, the DCS group has a higherexcellent rate of the kolment score, a lower incidence of pain, a longer hospital stay,and a more quantity of drainage after operation. However,there are no significantdifference in the incidence of genu varus, infection, nonunion and stiff knee joint.The quantity of included studies in this Meta-analysis were less，and the quality werenot high and the selection bias, information bias and confounding bias can not beavoided which could have influence of the results. We expect larger sample and highquality epidemiologic studies to further improve the results of this research.