{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:18:21Z","timestamp":1784557101528,"version":"3.55.0"},"reference-count":33,"publisher":"Bioscientifica","issue":"3","license":[{"start":{"date-parts":[[2024,3,1]],"date-time":"2024-03-01T00:00:00Z","timestamp":1709251200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["eor.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,3,1]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>The fixation method of distal, extra-articular femur fractures is a controversially discussed. To ensure better stability itself, earlier mobilization and to prevent blood loss \u2013 all these are justifications for addressing the femur via reamed intramedullary nailing (RIMN). Anatomical reposition of multifragmentary fractures followed by increased risks of non-union are compelling reasons against it. The purpose of this study was to systematically review the literature for rates of non-union and wound infection, as well as blood loss and time of surgery.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>According to the PRISMA guidelines we conducted this systematic review by searching the Cochrane, PubMed, Ovid, MedLine, and Embase databases. Inclusion criteria were the modified Coleman methodology score (mCMS) &gt;60, age &gt;18 years, and extra-articular fractures of the distal femur. Biomechanical and animal studies were excluded. By referring to title and abstract relevant articles were reviewed independently. In the consecutive meta-analysis, we compared 9 studies and 639 patients.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>\n                          There is no statistically significant difference comparing superficial wound infections when RIMN was performed (OR\u2009=\u20090.50; 95% CI: 0.18 \u2013 1.42;\n                          <jats:italic>P<\/jats:italic>\n                          \u2009=\u20090.19) as well as in deep wound infections (OR\u2009=\u20090.74; 95% CI: 0.19\u20132.81;\n                          <jats:italic>P<\/jats:italic>\n                          \u2009=\u20090.62). However, these results were not significant. We also calculated for potential differences in the rate of non-unions depending on the surgical treatment applied. Data of 556 patients revealed an overall number of 43 non-unions. There was no significant difference in rate of non-unions between both groups (OR\u2009=\u20090.97; 95% CI: 0.51\u20131.85;\n                          <jats:italic>P<\/jats:italic>\n                          \u2009=\u20090.92).\n                        <\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>No statistical difference was found in our study among RIMN and plate fixation in the treatment of distal femoral fractures with regard to the incidence of non-union and wound infections. Therefore, the indication for RIMN or plating should be made individually and based on the surgeon\u2019s experience.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:sec>","DOI":"10.1530\/eor-22-0140","type":"journal-article","created":{"date-parts":[[2024,3,5]],"date-time":"2024-03-05T07:20:30Z","timestamp":1709623230000},"page":"210-216","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-16","source":"Crossref","is-referenced-by-count":0,"title":["Non-unions and wound infections do not differ following intramedullary nailing and plate osteosynthesis for distal third femur fractures: a meta-analysis"],"prefix":"10.1530","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3899-9345","authenticated-orcid":true,"given":"Andreas","family":"Frodl","sequence":"first","affiliation":[{"name":"Department of Orthopedics and Traumatology, Freiburg University Hospital, Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Hauss","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Freiburg University Hospital, Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Fuchs","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Freiburg University Hospital, Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Siegel","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Freiburg University Hospital, Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hagen","family":"Schmal","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University Hospital Odense, Odense, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"K\u00fchle","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Freiburg University Hospital, Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"bib1","series-title":"Indian Journal of Orthopaedics","first-page":"646","article-title":"Comparing intramedullary nailing versus locked plating in the treatment of native distal femur fractures: is one superior to the other?","volume":"55","author":"Jankowski","year":"2021","unstructured":"Jankowski JMSzukics PFShah JKKeller DMPires RELiporace FA & Yoon RS. Comparing intramedullary nailing versus locked plating in the treatment of native distal femur fractures: is one superior to the other?Indian Journal of Orthopaedics202155646\u2013654. (https:\/\/doi.org\/10.1007\/s43465-020-00331-z)"},{"issue":"Supplement 3","key":"bib2","series-title":"Injury","first-page":"C62","article-title":"The epidemiology of fractures of the distal femur","volume":"31","author":"Martinet","year":"2000","unstructured":"Martinet OCordey JHarder YMaier AB\u00fchler M & Barraud GE. The epidemiology of fractures of the distal femur. Injury200031(Supplement 3) C62\u2013C63. (https:\/\/doi.org\/10.1016\/s0020-1383(0080034-0)"},{"key":"bib3","series-title":"Clinics in Orthopedic Surgery","first-page":"307","article-title":"Retrograde intramedullary nailing for distal femur fracture with osteoporosis","volume":"4","author":"Kim","year":"2012","unstructured":"Kim JKang SBNam KRhee SHWon JW & Han HS. Retrograde intramedullary nailing for distal femur fracture with osteoporosis. Clinics in Orthopedic Surgery20124307\u2013312. (https:\/\/doi.org\/10.4055\/cios.2012.4.4.307)"},{"key":"bib4","series-title":"Archives of Orthopaedic and Trauma Surgery","first-page":"49","article-title":"Distal femoral fractures in the elderly: biomechanical analysis of a polyaxial angle-stable locking plate versus a retrograde intramedullary nail in a human cadaveric bone model","volume":"135","author":"Bliemel","year":"2015","unstructured":"Bliemel CBuecking BMueller TWack CKoutras CBeck TRuchholtz S & Zettl R. Distal femoral fractures in the elderly: biomechanical analysis of a polyaxial angle-stable locking plate versus a retrograde intramedullary nail in a human cadaveric bone model. Archives of Orthopaedic and Trauma Surgery201513549\u201358. 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Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Medicine20096e1000097. (https:\/\/doi.org\/10.1371\/journal.pmed.1000097)"},{"key":"bib8","series-title":"Scandinavian Journal of Medicine and Science in Sports","first-page":"2","article-title":"Studies of surgical outcome after patellar tendinopathy: clinical significance of methodological deficiencies and guidelines for future studies. Victorian Institute of Sport tendon study Group","volume":"10","author":"Coleman","year":"2000","unstructured":"Coleman BDKhan KMMaffulli NCook JL & Wark JD. Studies of surgical outcome after patellar tendinopathy: clinical significance of methodological deficiencies and guidelines for future studies. Victorian Institute of Sport tendon study Group. Scandinavian Journal of Medicine and Science in Sports2000102\u201311. (https:\/\/doi.org\/10.1034\/j.1600-0838.2000.010001002.x)"},{"key":"bib9","series-title":"Journal of Bone and Joint Surgery. American Volume","first-page":"2632","article-title":"Level of evidence in orthopaedic journals","volume":"87","author":"Obremskey","year":"2005","unstructured":"Obremskey WTPappas NAttallah-Wasif ETornetta P & Bhandari M. Level of evidence in orthopaedic journals. Journal of Bone and Joint Surgery. American Volume2005872632\u20132638. (https:\/\/doi.org\/10.2106\/JBJS.E.00370)"},{"key":"bib10","article-title":"OCEBM levels of evidence - Centre for Evidence-Based Medicine (CEBM), University of Oxford","unstructured":"OCEBM levels of evidence - Centre for Evidence-Based Medicine (CEBM), University of Oxford [Internet]. Available at: https:\/\/www.cebm.ox.ac.uk\/resources\/levels-of-evidence\/ocebm-levels-of-evidence"},{"issue":"Supplement 3","key":"bib11","series-title":"Injury","first-page":"55","article-title":"Locking plate fixation versus antegrade intramedullary nailing for the treatment of extra-articular distal femoral fractures","volume":"50","author":"Ocalan","year":"2019","unstructured":"Ocalan EUstun CC & Aktuglu K. Locking plate fixation versus antegrade intramedullary nailing for the treatment of extra-articular distal femoral fractures. Injury201950(Supplement 3) 55\u201362. (https:\/\/doi.org\/10.1016\/j.injury.2019.07.008)"},{"key":"bib12","series-title":"Journal of Orthopaedics and Traumatology","first-page":"33","article-title":"Locking retrograde nail, non-locking retrograde nail and plate fixation in the treatment of distal third femoral shaft fractures: radiographic, bone densitometry and clinical outcomes","volume":"22","author":"Meccariello","year":"2021","unstructured":"Meccariello LBisaccia MRonga MFalzarano GCaraffa ARinonapoli GGrubor PPace V & Rollo G. Locking retrograde nail, non-locking retrograde nail and plate fixation in the treatment of distal third femoral shaft fractures: radiographic, bone densitometry and clinical outcomes. Journal of Orthopaedics and Traumatology20212233. (https:\/\/doi.org\/10.1186\/s10195-021-00593-9)"},{"key":"bib13","series-title":"Pakistan Journal of Medical and Health Sciences","first-page":"1144","article-title":"Outcome of Extra-Articular Fractures of Distal Femur: Less Invasive Stabilization on System (LISS) Plating versus Closed Retrograde intramedullary Interlocking Nail","volume":"15","author":"Mahar","year":"2021","unstructured":"Mahar SAAziz SAhmed SKumar J & Ali S. Outcome of Extra-Articular Fractures of Distal Femur: Less Invasive Stabilization on System (LISS) Plating versus Closed Retrograde intramedullary Interlocking Nail. Pakistan Journal of Medical and Health Sciences2021151144\u20131147. (https:\/\/doi.org\/10.53350\/pjmhs211551144)"},{"key":"bib14","series-title":"Journal of Clinical and Diagnostic Research","first-page":"RC19","article-title":"Extra articular supracondylar femur fractures managed with locked distal femoral plate or supracondylar nailing: a comparative outcome study","volume":"11","author":"Gill","year":"2017","unstructured":"Gill SMittal ARaj MSingh PSingh J & Kumar S. Extra articular supracondylar femur fractures managed with locked distal femoral plate or supracondylar nailing: a comparative outcome study. Journal of Clinical and Diagnostic Research201711RC19\u2013RC23. (https:\/\/doi.org\/10.7860\/JCDR\/2017\/25062.9936)"},{"key":"bib15","series-title":"Ulusal Travma ve Acil Cerrahi Dergisi\u2009=\u2009Turkish Journal of Trauma and Emergency Surgery","first-page":"148","article-title":"Bridge plate osteosynthesis using dynamic condylar screw (DCS) or retrograde intramedullary supracondylar nail (RIMSN) in the treatment of distal femoral fractures: comparison of two methods in a prospective randomized study","volume":"15","author":"Dar","year":"2009","unstructured":"Dar GNTak SRKangoo KA & Halwai MA. Bridge plate osteosynthesis using dynamic condylar screw (DCS) or retrograde intramedullary supracondylar nail (RIMSN) in the treatment of distal femoral fractures: comparison of two methods in a prospective randomized study. Ulusal Travma ve Acil Cerrahi Dergisi\u2009=\u2009Turkish Journal of Trauma and Emergency Surgery200915148\u2013153."},{"key":"bib16","series-title":"Archives of Orthopaedic and Traumatic Surgery","first-page":"73","article-title":"Supracondylar femoral fractures in elderly patients treated with the dynamic condylar screw and the retrograde intramedullary nail: a comparative study of the two methods","volume":"125","author":"Christodoulou","year":"2004","unstructured":"Christodoulou ATerzidis IPloumis AMetsovitis SKoukoulidis A & Toptsis C. Supracondylar femoral fractures in elderly patients treated with the dynamic condylar screw and the retrograde intramedullary nail: a comparative study of the two methods. Archives of Orthopaedic and Traumatic Surgery200412573\u201379. (https:\/\/doi.org\/10.1007\/s00402-004-0771-5)"},{"key":"bib17","series-title":"ANZ Journal of Surgery","first-page":"290","article-title":"Retrograde nailing versus fixed-angle blade plating for supracondylar femoral fractures: a randomized controlled trial","volume":"76","author":"Hartin","year":"2006","unstructured":"Hartin NLHarris I & Hazratwala K. Retrograde nailing versus fixed-angle blade plating for supracondylar femoral fractures: a randomized controlled trial. ANZ Journal of Surgery200676290\u2013294. (https:\/\/doi.org\/10.1111\/j.1445-2197.2006.03714.x)"},{"key":"bib18","series-title":"Clinical Orthopaedics and Related Research","first-page":"252","article-title":"Femur-LISS and distal femoral nail for fixation of distal femoral fractures: are there differences in outcome and complications?","volume":"426","author":"Markmiller","year":"2004","unstructured":"Markmiller MKonrad G & S\u00fcdkamp N. Femur-LISS and distal femoral nail for fixation of distal femoral fractures: are there differences in outcome and complications?Clinical Orthopaedics and Related Research2004426252\u2013257. (https:\/\/doi.org\/10.1097\/01.blo.0000141935.86481.ba)"},{"key":"bib19","series-title":"Indian Journal of Orthopaedics","first-page":"243","article-title":"Outcome analysis of retrograde nailing and less invasive stabilization system in distal femoral fractures: A retrospective analysis","volume":"45","author":"Hierholzer","year":"2011","unstructured":"Hierholzer Cvon R\u00fcden CP\u00f6tzel TWoltmann A & B\u00fchren V. Outcome analysis of retrograde nailing and less invasive stabilization system in distal femoral fractures: A retrospective analysis. Indian Journal of Orthopaedics201145243\u2013250. (https:\/\/doi.org\/10.4103\/0019-5413.80043)"},{"key":"bib20","series-title":"BMJ","first-page":"i4919","article-title":"Robins-I: a tool for assessing risk of bias in non-randomised studies of interventions","volume":"355","author":"Sterne","year":"2016","unstructured":"Sterne JAHern\u00e1n MAReeves BCSavovi\u0107 JBerkman NDViswanathan MHenry DAltman DGAnsari MTBoutron I, et al.Robins-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ2016355i4919. (https:\/\/doi.org\/10.1136\/bmj.i4919)"},{"key":"bib21","series-title":"BMJ","first-page":"d5928","article-title":"The Cochrane Collaboration\u2019s tool for assessing risk of bias in randomised trials","volume":"343","author":"Higgins","year":"2011","unstructured":"Higgins JPTAltman DGG\u00f8tzsche PCJ\u00fcni PMoher DOxman ADSavovic JSchulz KFWeeks LSterne JA, et al.The Cochrane Collaboration\u2019s tool for assessing risk of bias in randomised trials. BMJ2011343d5928. (https:\/\/doi.org\/10.1136\/bmj.d5928)"},{"key":"bib22","series-title":"BMC Medical Research Methodology","first-page":"135","article-title":"Estimating the sample mean and standard deviation from the sample size, median, range and\/or interquartile range","volume":"14","author":"Wan","year":"2014","unstructured":"Wan XWang WLiu J & Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and\/or interquartile range. BMC Medical Research Methodology201414135. (https:\/\/doi.org\/10.1186\/1471-2288-14-135)"},{"key":"bib23","series-title":"BMC Medical Research Methodology","first-page":"13","article-title":"Estimating the mean and variance from the median, range, and the size of a sample","volume":"5","author":"Hozo","year":"2005","unstructured":"Hozo SPDjulbegovic B & Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Medical Research Methodology2005513. (https:\/\/doi.org\/10.1186\/1471-2288-5-13)"},{"issue":"Supplement 1","key":"bib24","series-title":"Journal of Orthopaedic Trauma","first-page":"S8","article-title":"Locking plates for distal femur fractures: is there a problem with fracture healing?","volume":"25","author":"Henderson","year":"2011","unstructured":"Henderson CEKuhl LLFitzpatrick DC & Marsh JL. Locking plates for distal femur fractures: is there a problem with fracture healing?Journal of Orthopaedic Trauma201125(Supplement 1) S8\u2013S14. (https:\/\/doi.org\/10.1097\/BOT.0b013e3182070127)"},{"key":"bib25","series-title":"Journal of Orthopaedic Trauma","first-page":"264","article-title":"Fractures of the proximal third of the tibial shaft treated with intramedullary nails and blocking screws","volume":"15","author":"Ricci","year":"2001","unstructured":"Ricci WMO\u2019Boyle MBorrelli JBellabarba C & Sanders R. Fractures of the proximal third of the tibial shaft treated with intramedullary nails and blocking screws. 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(https:\/\/doi.org\/10.1097\/00005131-200605000-00013)"},{"key":"bib27","series-title":"Bone and Joint Journal","first-page":"1317","article-title":"The 30-day survival and recovery after hip fracture by timing of mobilization and dementia\u202f: a UK database study","volume":"103\u2013B","author":"Goubar","year":"2021","unstructured":"Goubar AMartin FCPotter CJones GDSackley CAyis S & Sheehan KJ. The 30-day survival and recovery after hip fracture by timing of mobilization and dementia\u202f: a UK database study. Bone and Joint Journal2021103\u2013B1317\u20131324. (https:\/\/doi.org\/10.1302\/0301-620X.103B7.BJJ-2020-2349.R1)"},{"key":"bib28","series-title":"Archives of Bone and Joint Surgery","first-page":"141","article-title":"Locked plating versus retrograde intramedullary nailing for distal femur fractures: a systematic review and meta-analysis","volume":"10","author":"Neradi","year":"2022","unstructured":"Neradi DSodavarapu PJindal KKumar DKumar V & Goni V. 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(https:\/\/doi.org\/10.1159\/000342664)"},{"key":"bib30","series-title":"Acta Orthopaedica","first-page":"22","article-title":"Treatment of acute distal femur fractures above a total knee arthroplasty: systematic review of 415 cases (1981\u20132006)","volume":"79","author":"Herrera","year":"2008","unstructured":"Herrera DAKregor PJCole PALevy BAJ\u00f6nsson A & Zlowodzki M. Treatment of acute distal femur fractures above a total knee arthroplasty: systematic review of 415 cases (1981\u20132006). Acta Orthopaedica20087922\u201327. (https:\/\/doi.org\/10.1080\/17453670710014716)"},{"issue":"Supplement 2","key":"bib31","series-title":"Injury","first-page":"S11","article-title":"Risk factors contributing to fracture non-unions","volume":"38","author":"Calori","year":"2007","unstructured":"Calori GMAlbisetti WAgus AIori S & Tagliabue L. Risk factors contributing to fracture non-unions. Injury200738(Supplement 2) S11\u2013S18. 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Comparative efficacy of 2 different demineralized bone matrix allografts in treating long-bone nonunions in heavy tobacco smokers. American Journal of Orthopedics200534329\u2013332."}],"container-title":["EFORT Open Reviews"],"original-title":[],"link":[{"URL":"https:\/\/eor.bioscientifica.com\/view\/journals\/eor\/9\/3\/EOR-22-0140.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/eor.bioscientifica.com\/downloadpdf\/journals\/eor\/9\/3\/EOR-22-0140.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/eor.bioscientifica.com\/downloadpdf\/journals\/eor\/9\/3\/EOR-22-0140.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T13:50:58Z","timestamp":1784555458000},"score":1,"resource":{"primary":{"URL":"http:\/\/journals.bioscientifica.com\/eor\/article\/9\/3\/210-216\/2623"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,1]]},"references-count":33,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.1530\/eor-22-0140","relation":{},"ISSN":["2058-5241"],"issn-type":[{"value":"2058-5241","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,1]]}}}