Study finds, Helical Blade Leads to Higher Rates of Fixation
Recently, several studies have suggested that blade-type cephalomedullary nails (CMNs) have a higher risk of fixation failure than that of lag screws. This study compared fixation failure between helical blade-type and lag screw-type CMNs with cut-out and cut-through rates as primary outcomes and degree of sliding length, time to union, and nonunion rate as secondary outcomes.

Studies were included if they directly compared helical blade and lag screw for treating hip fractures. Data could be extracted for CMN alone to avoid mixing CMN and extramedullary plate devices, such as the dynamic hip screw.

All data were pooled using a random-effects model. For all comparisons, odds ratios (ORs) and 95% confidence intervals (CIs) were calculated as dichotomous data, whereas continuous data were analyzed using mean differences with 95% CIs.

Fixation failure (OR = 1.88), particularly cut-through (OR = 5.33), was more likely with helical blades than with lag screws, despite the fact that the cut-out rate was not substantially different between the two groups (OR = 0.87). When treating hip fractures, surgeons should carefully select a blade-type CMN.