How the Choice of Osteosynthesis Affects the Complication Rate of Intercalary Allograft Reconstruction? A Systematic Review and Meta-analysis

• Published in: Indian journal of orthopaedics 2022-04, Vol.56 (4), p.547-558
• Main Authors: Jamshidi, Khodamorad, Bahardoust, Mansour, Karimi Behnagh, Arman, Bagherifard, Abolfazl, Mirzaei, Alireza
• Format: Article
• Language: English
• Subjects: Conservative Orthopedics; Medicine; Medicine & Public Health; Orthopedics; Review; Review Article; Surgical Orthopedics
• ISSN: 0019-5413; 1998-3727
• DOI: 10.1007/s43465-021-00563-7

Background There is no clear consensus on the optimal type of fixation in intercalary allograft reconstruction. In this study, we aimed to compare the rate of most common complications following the plate and nail fixation of the intercalary allograft. Materials and Methods We searched PubMed, EMBASE, Web of Science, Scopus, and Cochrane Library. Studies in which the complication rate of the single bridging plate and intramedullary nail fixation was extractable were included. Studies that used extra procedures such as cementation and fibular vascular graft augmentation were excluded. The primary outcome was the fixation-specific rate of nonunion. Secondary outcomes were the fixation-specific rate of fracture, infection, and local recurrence. Results In total, 13 studies with 431 reconstructions (352 reconstructions in the plate group and 79 reconstructions in the intramedullary nailing group) were included in this study. In the plate fixation, the rate of nonunion, fracture, infection and local recurrence was 12%, 11%, 11%, and 3%, respectively. In the intramedullary nail fixation, the rate of nonunion, fracture, infection, and local recurrence was 37%, 5%, 4%, and 0%, respectively. The rate of nonunion was significantly higher in the intramedullary nail group ( OR  = 6.34; 95% CI 2.98–13.49, P