Meta-analysis suggests that the electromagnetic technique is better than the free-hand method for the distal locking during intramedullary nailing procedures

Objectives: To evaluate the comparative effectiveness and accuracy of electromagnetic technique (EM) verses free-hand method (FH) for distal locking in intramedullary nailing procedure.

Material and methods: Relevant original studies were searched in Medline, Pubmed, Embase, China National Knowledge Infrastructure, and Cochrane Central Database (all through October 2015). Comparative studies providing sufficient data of interest were included in this meta-analysis. The Stata 11.0 was used to analyze all data.

Results: Eight studies involving 611 participants were included, with 305 in EM group and 306 in FH group. EM outperformed FH with reduced distal locking time of 4.1 minutes [standardized mean difference (SMD), 1.61; 95 % confidence interval (95 %CI), 0.81 to 2.41] and the reduced fluoroscopy time of 25.3 seconds (SMD, 2.64; 95 %CI, 2.12 to 3.16). Regarding the accuracy of distal screw placement, no significant difference was observed between two techniques (OR, 2.39; 95 %CI, 0.38 to 15.0). There was a trend of longer operative time in FH versus EM by 10 minutes (79.0 and 69.0 minutes), although the difference was not statistically significant (SMD, 0.341; 95 % CI, -0.02 to 0.703).

Conclusions: The existing evidence suggests EM technique is a better alternative for distal locking in intramedullary nailing procedure, and this might aid in the management of diaphyseal fractures in lower extremities.