A Meta-analysis：the Retrograde Intramedullary Nail(RIN) And Dynamic Condylar Screw(DCS)in The Treatment Of Distal Femoral Fractures

BACKGROUND：The treatment of distal femoral fractures has evolved over theyears, but despite this, It remains a significant surgical challenge for these fracturesare usually complex and their management is fraught with a wide range of potentialcomplications. Surgical fixation methods have been advocated using various implantsincluding retrograde intramedullary nail(RIN), dynamic condylar screw（DCS）, LessInvasive Stabilization System(LISS), locking condylar plate (LCP), angle blade plates,the Zickel device, Rush rods. The retrograde intramedullary nail is the standard carefor distal femoral fractures. However, the difficult removal of the nail and unknownadverse effects on the knee are its disadvantages. Minimally invasive surgicaltechniques using dynamic condylar screw provide favorable results in distal femoralfractures. Controversies between the proponents of different implants and operativetechniques have occupied the attention of most of the reports. Some prospectiverandomized study was undertaken to compare the results of using DCS and RIN in thetreatment of distal femoral fractures，but these conclusion is not consistent. Classicretrograde intramedullary nail and dynamic condylar screw is widely used in manycountries and regions and is still more than other treatment of distal femoral fracturefixation in the number. In view of the number of the comparative study of the twomethods and the appearance of the new comparative study publishe.We madeMeta-analysis of the two treatments above to expect to provide evidence basedmedicine for clinical decision making.OBJECTIVE： To evaluate clinical therapeutic effect of the retrogradeintramedullary nail(RIN) and dynamic condylar screw（DCS）in the treatment of distalfemoral fractures. METHODS：We collect randomized controlled trials(RCT) and case-control study（CC）from the following data source（s1996-2013年）: Cochrane、PubMed、OVID、Embase、SciVerse Hub、CINII、Papersearch.et.Evaluate the quality of all studies. Usethe Review Manager5.2software provided by Cochrane Collaboration to analyze thedatum. Use standard mean difference (SMD) to count continuous variables, odds ratio(OR)to count two categorical variables.RESULTS：Five studies were included, Meta-analysis showed that retrogradeintramedullary nail and dynamic condylar screw, no significant difference in fracturehealing excellent and good rate[OR=1.00，95%CI(0.52，1.95)，P=0.99], the differenceof knee joint stiffness incidence was not statistically significant [OR=1.69，95%CI(0.66，4.37)， P=0.28], varus difference incidence was not statisticallysignificant [OR=0.80，95%CI(0.20，3.14)， P=0.75], no statistically significantdifference in the incidence of nonunion [OR=1.25，95%CI(0.36，4.30)，P=0.72].Retrograde intramedullary nail group had less blood loss than the dynamic condylarscrew group during intra-operation, there was significant difference [SMD=2.82,95%CI (1.54,4.10), P <0.00001].CONCLUSION：There were no differences between RIN and DCS in stiffnessrate，varus deformitie rate and nonunion rate.And there were no differences betweenthe two groups in the excellent and good rate of fracture healing. However，the RINhad less blood loss in the sugery comparing with DCS.