Treatment Trade-Offs and Choices for Femoral Fractures: A Systematic Review and Meta-Analysis.

Abstract

In resource-limited settings, selecting the appropriate treatment for femoral fractures is crucial as it affects both patient recovery and the efficient use of medical resources. This review explores the treatment options for adult and elderly patients with surgical contraindications suffering from femoral fractures, with a particular emphasis on the trade-offs between surgical intervention and traction therapy. Through a systematic literature search of major databases such as PubMed, Web of Science, and the Cochrane Library, we identified 39 studies that met the inclusion criteria, focusing on complications, treatment effectiveness, functional recovery, and cost analysis. We found that although intramedullary nailing may offer better clinical outcomes, traction therapy often becomes the treatment of choice in resource-poor environments due to limited surgical resources. The professional judgment of physicians (OR 10.81; 95% CI 8.28-14.11), patient preferences (OR 1.33; 95% CI 0.80-2.21), and hospital surgical capacity (OR 1.87; 95% CI 0.56-6.28) are key factors influencing treatment choice. For elderly patients, the choice of treatment requires a balance between the risks of surgery and the potential complications of non-surgical treatment (OR 0.78; 95% CI 0.10-5.90). Ultimately, the decision-making process is complex and requires a comprehensive consideration of available resources, cost-effectiveness, patient health status, physician experience, patient preferences, and expected clinical outcomes. In resource-constrained areas, this process is particularly challenging and necessitates a careful consideration of the risks and benefits of both surgical and non-surgical treatment options.