Table 2.
Characteristics, results and conclusions of studies published in the last five years comparing distally locked versus unlocked nails in stable pertrochanteric fractures
| Study | Type | N | Follow-up | Locking | Operation time (min) |
Length of incision (cm) | Fluoroscopy time (s) |
Blood loss (mL/Hb) |
Other results | Conclusions | ||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LG | UG | LG | UG | LG | UG | LG | UG | |||||||
| Yan et al, 202032 | Meta-analysis | 480–800 | 10–18 months | Locked/ Unlocked | – | SMD 0.77 (CI 0.36–1.17) |
– | SMD 1.16 (CI 0.86–1.47) |
– | SMD 1.44 (CI 0.46–2.41) |
– | SMD 0.80 (CI 0.62–0.99) |
– | Locked nails should not be recommended for stable fractures |
| Ciaffa et al, 201833 | RCT | 240 | 12 months | Static/ Dynamic/Unlocked | DG 39.4 ± 4.7 SG 40.1 ± 3.7 |
33.8 ± 6.3 | DG 13.5 ± 2.3 SG 13.8 ± 3.0 |
11.4 ± 2.2 | DG 56.3 ± 7.0 SG 54.2 ± 8.0 |
48.4 ± 3.3 | DG 172.4 ± 38.0 SG 174.2 ± 3.4 |
152.6 ± 43.0 | – | Short nails do not need to be locked |
| Lanzetti et al, 201834 | Cohort study | 143 | 12–19 months | Dynamic/Unlocked | 47.16 ± 13.26 | 31.87 ± 18.26 | – | – | 31.59 | 25.40 | 11.61 ± 1.65 * |
11.08 ± 1.41 * |
– | In stable fractures, the absence of locking does not compromise bone healing and prevents complications |
| Caiaffa et al, 201610 | RCT | 266 | 12 months | Locked/ Unlocked | 41.3 ± 9.5 | 36.6 ± 8.1 | 11.2 ± 1.8 | 8.5 ± 2.1 | 52.0 ± 4.2 | 43.0 ± 3.5 | 185.3 ± 44.6 | 137.6 ± 57.6 | DL associated with greater thigh pain (26.9% LG vs. 5% UG) | Stable fractures can be treated successfully with unlocked nails |
| Li et al, 201535 | RCT | 70 | 12 months | Static/ Unlocked | 48.5 ± 9.0 | 39.2 ± 7.6 | 13.1 ± 2.1 | 10.9 ± 1.7 | 57.8 ± 4.3 | 53.7 ± 3.9 | 194.3 ± 61.6 | 158.6 ± 63.6 | – | Unlocked nails may be an acceptable option for stable fractures |
| López-Vega et al, 201536 | RCT | 177 | 10 months | Dynamic/Unlocked | 41.07 ± 16.42 | 40.06 ± 19.46 | – | – | 31.59 ± 30.34 | 25.40 ± 21.44 | 2.06 ± 0.81** | 2.09 ± 0.92** | More complications in LG: medical (36 vs. 23) biomechanical (5 vs. 14) fracture collapse (5.41 ± 4.51 vs. 3.78 ± 3.39) |
The use of distal locking screw in the Gamma 3 nails should be restricted to unstable fractures |
Note. N, number of cases; LG, locked group; UG, unlocked group; DG, dynamic group; SG, static group; Hb, hemoglobin g/dL; CI, confidence interval (95%); RCT, randomized controlled study; SMD, standardized mean difference.
*postoperative; **variation pre/postoperative.
All the patients presented with AO A1 or A2 fracture patterns.