Clinical efficacy and complications of blocking screw in the treatment of lower limb long bone fracture: An updated systematic review and meta-analysis

Abstract

Background: Blocking screw technique has been widely applied in the treatment of long shaft fractures. However, the evidence with regard to whether intramedullary nail combined with blocking screw technique has better clinical efficacy over other is not clear. The aim of the study was to explore the clinical efficacy and complications of intramedullary nail combined with blocking screw technique in the treatment of femoral or tibial shaft fractures. Methods: The PuMed, Embase, OVID, Cochrane library, Web of Science, Wanfang, CNKI and Weipu data were searched for studies of intramedullary nail combined with blocking screw in treatment of femoral or tibial shaft fracture published up to Aug 31 2023. Methodological quality of the trials was assessed, relevant data were extracted, and RevMan 5.3 and Stata 15.0 software were used to perform the meta-analysis of parameters related to the consequences. Result: Twenty articles were included, including 1267 patients. Meta-analysis results showed that compared with the non-blocking screw group, the blocking screw group had longer operation time (WMD = 13.24; 95% CI = 5.68–20.79, P = .0006) and more intraoperative fluoroscopy times (WMD = 57.62; 95% CI = 25.82–89.42, P = .0002). However, the postoperative therapeutic response rate was higher (OR = 5.60; 95% CI = 2.10–14.93, P = .0006), postoperative ankle joint function was better (OR = 3.48; 95% CI = 1.20–10.13, P = .02), and fracture healing rate was higher (OR = 3.56; 95% CI = 1.43–8.89, P = .006), fracture healing time was shorter (WMD = −3.59; 95% CI = −4.96 to −2.22, P < .00001), intraoperative blood loss was less (WMD = −54.80; 95% CI = −88.77 to −20.83, P = .002), hospitalization time was shorter (WMD = −1.66; 95% CI = −2.08 to −1.24, P < .00001), and complications were less (OR = 0.38; 95% CI = 0.16–0.89, P = .01). There was no statistical significance in the range of motion of knee joint between the 2 groups (WMD = 10.04; 95% CI = −1.51 to 21.59, P = .09). Conclusions: Current evidence shows that intramedullary nail combined with blocking screw technique in the treatment of lower limb long bone fracture has the advantages of good clinical efficacy, high fracture healing rate, short fracture healing time, good joint function, less complications and so on, which is worthy of clinical recommendation.