Exploring the Efficacy of Computer-Assisted Navigation in Improving Lag Screw Placement and Preventing Cut-Out in Intramedullary Nail Fixation of Femoral Fractures: A Meta-Analysis.

Femoral neck fractures are a common complication treated by orthopedic surgeons. Exploring the role of computer-assisted orthopedic programs in femoral fracture treatment is of particular interest given the technological advances in computer-assisted programs in the medical field. Notably, systems such as Stryker's Adaptive Positioning Technology (ADAPT) may allow for more precision in determining the tip-apex distance (TAD) when treating intertrochanter femur fractures. Such innovations hold the potential to reduce complication rates, including the incidence of lag screw cut-out, which could improve clinical outcomes in intertrochanter femur fracture treatment. This meta-analysis aims to evaluate the effectiveness of computer-assisted orthopedic systems in improving lag screw placement, as determined by the TAD and, ultimately, screw cut-out. Three studies were compared that reported continuous data for TAD in groups that did and did not use Stryker's ADAPT computer-assisted system. A random effects model was utilized to identify heterogeneity between studies. This was determined by variation and calculated through Cochran's Q-test, I2 statistic, and Tau2. Operative time was also reported in these studies and was evaluated as a secondary outcome. Each study analyzed showed that ADAPT had a statistically significant improvement in TAD with an overall effect size of -5.06. However, with an I2 value of 89% (p<0.01), there was notable heterogeneity between the three studies compared in this meta-analysis. While it is clear that there are benefits to using computer-assisted technology for internal femur fixation, more research is needed to understand the implications, including operative time and possible improvements in screw position.