Surgical management of bifocal femoral fractures: a systematic review and pooled analysis of treatment with a single implant versus double implants.

J D Cnossen, Esther M M Van Lieshout, Michael H J Verhofstad

Open access · hybridAbstract readSystematic Review

In one paragraph

Synthesis in Archives of orthopaedic and trauma surgery, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it

0cells of the map it votes in

4citing papers in PubMed

0.6field-weighted citation impact, top 30% of its field

1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 2 citations in OpenAlex.

Finite element analysis of four different fixation methods for the treatment of ipsilateral femoral neck and shaft fractures.BMC musculoskeletal disorders · 2026
Article
Smoking and injury severity score predict major complications after surgical treatment of ipsilateral proximal and shaft femoral fractures.SICOT-J · 2026
Article
[Multilevel injuries of the upper and lower legs : Strategies for osteosynthetic treatment].Unfallchirurgie (Heidelberg, Germany) · 2025
Review
Intramedullary arthrodesis of the knee joint with additional femoral neck screw to prevent periprosthetic fracture of the proximal femur. A case report.GMS Interdisciplinary plastic and reconstructive surgery DGPW · 2024
Article

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

3 authors at 1 institution in 1 country.

J D CnossenTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.ORCID http://orcid.org/0000-0001-6361-3099

Esther M M Van LieshoutTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. e.vanlieshout@erasmusmc.nl.ORCID http://orcid.org/0000-0002-2597-7948

Michael H J VerhofstadTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.ORCID http://orcid.org/0000-0001-8448-5903

Erasmus MC · NL

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionFractures 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. MATERIALS AND

methodsA 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.

resultsFor 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.

conclusionsThe 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.

Indexed as

Femoral FracturesFracture Fixation, IntramedullaryBone NailsFemurFracture HealingHumansPostoperative ComplicationsRetrospective StudiesTreatment OutcomeBifocal fracturesFemoral shaft fracturesIntramedullary nailingProximal femur

Identifiers

PMID37405462

DOI10.2106/00004623-196951040-00012

PMCPMC10491515

OpenAlexW4383186125

What OpenQuestion holds

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LicenceCC BY

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.