SynthesisInternational orthopaedics2018
Healing, nonunion, and re-operation after internal fixation of diaphyseal and distal femoral fractures: a systematic review and meta-analysis.
Synthesis in International orthopaedics, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 51 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
51 citing papers in PubMed, 2 syntheses or guidelines pooled it, 112 citations in OpenAlex.
- Combined nail-plate constructs in the management of osteoporotic native distal femoral fractures: a systematic review of the available evidence.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2023Pooled it
- Incidence of nonunion after surgery of distal femoral fractures using contemporary fixation device: a meta-analysis.Archives of orthopaedic and trauma surgery · 2021Pooled it
- Predicting nonunion - a hybrid machine-learning model combining patient factors and mechanobiological simulation features exceeds clinician accuracy.Bone & joint research · 2026Article
- Article
- Preoperative ketorolac is associated with increased nonunion repair following femoral intramedullary nailing: a retrospective cohort study.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2026Article
- Experimental study on the effect of warm acupuncture on the healing of bone nonunion in rats.Journal of the Chinese Medical Association : JCMA · 2026Article
- [Biphasic plate-Controlled instability in fracture healing].Unfallchirurgie (Heidelberg, Germany) · 2025Review
- Preclinical validation of finite element models for predicting in vivo residual plate bending using continuous implant sensor data.Journal of orthopaedic translation · 2025Article
- Clinical outcomes of internal fixation orthopaedic surgery in humanitarian settings: a retrospective cohort study at the Médecins Sans Frontières (MSF) trauma centre in Aden, Yemen.International orthopaedics · 2025Article
- Open reduction, internal fixation of Vancouver B1, C & D type periprosthetic femoral fractures with use of an antiglide plate at fracture apex - The "Apex Plate".Trauma case reports · 2025Article
- Intramedullary Nailing in Femoral Diaphyseal Fractures: A Retrospective Multicenter Cohort Study.Life (Basel, Switzerland) · 2025Article
- Far cortical locking versus standard locking screw fixation in simulated femoral fractures: A biomechanical meta-analysis.Journal of orthopaedics · 2025Review
- Exploring the Efficacy of the Ilizarov Method for Infected Femoral Non-unions in Pediatric and Adult Populations.Cureus · 2025Article
- Distal femur fractures: The use of a fibular strut allograft with dual locking plates allows for early weight bearing.BioMedicine · 2025Article
- Management of Distal Femoral Non-union: A Systematic Review.Indian journal of orthopaedics · 2024Review
- Femoral shaft fracture with a third fragment treated with an intramedullary nail: Is the displacement of the third fragment predictive of nonunion?European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2024Article
- Distal femoral fractures: periprosthetic fractures have four times more complications than non-periprosthetic fractures and cerclage should be avoided: retrospective analysis of 206 patients.Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology · 2024Article
- Article
- Multiple fractures after low-energy trauma in an immunosuppressed lung transplant patient with severe osteoporotic bone texture-a challenge for traumatology and osteology.Journal of surgical case reports · 2024Article
- Incidence of complications and functional outcomes following segmental femoral shaft fractures: a critical review of the literature.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2024Review
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeNonunion is a highly morbid complication that exacerbates the pain, disability and financial burden of distal and diaphyseal femur fractures. This study examined the modern rates of healing, nonunion, and other complications requiring reoperation of different fixation methods for distal and diaphyseal femur fractures.
methodsA systematic review and meta-analysis of all records from PubMed, Embase and the Cochrane Review system was performed. Included studies had >20 acute, non-pathologic distal or diaphyseal femur fractures treated with primary internal fixation. Excluded were studies on abnormal patient/fracture populations, external fixation, or cement/bone graft use.
resultsThirty-eight studies with 2,829 femoral shaft fractures and 11 studies with 505 distal femur fractures were included. Distal fractures had a lower healing rate (86.6% vs. 93.7%) and a higher re-operation rate (13.4% vs 6.1%) than shaft fractures (p < 0.00001), primarily due to higher rates of mechanical failure (p < 0.00001). Nonunion was the most frequent complication, occurring in 4.7% of distal fractures and 2.8% of shaft fractures. There was no difference between plate and nail fixation of distal fractures in healing, nonunion, or other causes of re-operation. Shaft fractures developed nonunion in 6.6% of unreamed nails and 2.1% of reamed nails (p = 0.002). Nonunion occurred in 2.3% of antegrade nailed fractures and 1.5% of retrograde nailed fractures (p = 0.66).
conclusionsApproximately one out of every eight distal fractures and one of every 16 shaft fractures requires re-operation. The most common cause of fixation failure is nonunion. Further research is needed to improve outcomes, particularly in distal femur fractures.
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Registered trials
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