Comparison of helical blade versus lag screw in intertrochanteric fractures of the elderly treated with proximal femoral nail: A meta-analysis of randomized-controlled trials

Abstract

Currently, there are two surgical ways to treat intertrochanteric fractures among the elderly, including extramedullary or intramedullary fixation. [1,2] Although extramedullary fixation is the conventional treatment of intertrochanteric fractures, intramedullary fixation has become a more popular method with the development and progress of intramedullary instruments. [3] The optimal choice between the helical blade and lag screw is still controversial. [4][5][6] Some pieces of literature have reported that there is no difference in the clinical efficacy, excepted for the operation time that the lag screw is longer than that of the helical blade. [7] However, biomechanical studies have shown that the helical blade is superior to the conventional solid lag Objectives: In this review, we aimed to compare the radiological and functional outcomes between the helical blade and lag screw in treating intertrochanteric fractures among the elderly and to provide suggestions for clinical treatment. Materials and methods:Between January 1 st , 1990 and January 12 th , 2022, the literature search in document databases identified eligible randomized-controlled trials (RCT) studies directly comparing the helical blade and lag screws for treating hip fractures. The mechanical failure rates, the excellent and good rate of fracture reduction, Harris Hip Score (HHS), and postoperative hip pain of two intramedullary devices (helical blades versus lag screws) in patients with intertrochanteric fractures were analyzed using the RevMan software and Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The random-effects models were used for statistical analysis.Results: A total of 11 articles containing 1,146 patients for helical blade and lag screw comparison were included. Compared to the lag screws, the mechanical failure rate (odds ratio [OR]=0.71, 95% confidence interval [CI] 0.40-1.27, p=0.25), the excellent and good rate of fracture reduction (OR=1.33, 95% CI 0.61-2.90, p=0.48), HHS (mean differences 1.83, 95% CI -0.29-1.83, p=0.09), and postoperative hip pain (OR=0.41, 95% CI 0.14-1.21, p=0.11) were similar with the helical blades. There was no significant difference between the two implants in terms of the treatment outcomes. Conclusion:Both helical blades and lag screws are good choices for treating intertrochanteric fracture among elderly.

Failure of Fixation in Trochanteric Hip Fractures: Does Nail Design Matter?

“…We found 3 systemic reviews and meta-analysis which compared the results of helical blade versus screw in the treatment of THF. 21,23,28 Kim et al 23 found a higher overall failure of fixation rate in the helical blade group (pooled OR of 1.88, P = 0.02). The authors compared the different failure mechanism either cut through or cut out for the 2 groups and found a higher failure rate in the helical blade group only for the cut through mechanism of failure.…”

“…Between January 2000 and March 2023, of 659 articles screened, 22 met the inclusion criteria and formed the basis of this study. 7,16–36…”

“…20 Comparison of sliding length, time to union, nonunion rates, and Harris hip score found no difference between the 2 groups. 20,21,23,28 Dual Lag Screws Versus Single Lag Screw…”

“…46 We found conflicting results regarding failure rate analysis reported by recent systematic reviews comparing screw versus helical blade fixation. Two systematic reviews reported no difference in failure rate between the groups 21,28 while Kim et al 2 23 found higher overall failure rates in the helical blade. The fact that one review included only RCTs 21 while the other included specific nail designs (PFNA versus PFN) 28 which were not included in the other reviews is possibly the reason for these conflicting results.…”

“…Two systematic reviews reported no difference in failure rate between the groups 21,28 while Kim et al 2 23 found higher overall failure rates in the helical blade. The fact that one review included only RCTs 21 while the other included specific nail designs (PFNA versus PFN) 28 which were not included in the other reviews is possibly the reason for these conflicting results. Additional comparisons including time to union, nonunion rates, and Harris hip score found no difference between the 2 groups.…”