Comparison of intramedullary fixation and arthroplasty for the treatment of intertrochanteric hip fractures in the elderly

Nie, Boyuan; Wu, Dou; Yang, Zhaohui; Liu, Qiang

doi:10.1097/md.0000000000007446

Cited by 50 publications

(57 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…For blood loss, there was a statistical difference between the two groups in favor of intramedullary nail with obvious heterogeneity, which is similar to the result from a previous study . Various methods to calculate the blood loss and different levels of expertise of the surgeons in those trials were sources of heterogeneity.…”

Section: Discussionsupporting

confidence: 77%

“…Another newly published systematic review had revealed that compared to intramedullary nail fixation, the use of arthroplasty could reduce the implant‐related complications and reoperations rates. But there were significant differences in terms of duration of surgery, blood loss, transfusion requirement, hip joint function, and mortality at 1 year in favor of intramedullary nail group . However, the intertrochanteric fractures in this review were not specific to unstable type.…”

Section: Introductionmentioning

confidence: 55%

See 1 more Smart Citation

Hip Replacement as Alternative to Intramedullary Nail in Elderly Patients with Unstable Intertrochanteric Fracture: A Systematic Review and Meta‐Analysis

Zhang

Jiang

2019

Orthopaedic Surgery

View full text Add to dashboard Cite

ObjectiveTo evaluate the efficacy and safety of hip replacement and intramedullary nails for treating unstable intertrochanteric fractures in elderly patients.MethodsRandomized clinical trials (RCTs) to compare hip replacement with intramedullary nail in the management of elderly patients with unstable intertrochanteric femur fracture were retrieved from Cochrane Library (up to January 2018), CNKI (China National Knowledge Infrastructure), Wanfang Data, PubMed, and Embase. The methodological quality of the included trials was assessed using the Cochrane risk of bias assessment tool, and relevant data was extracted. Statistical analysis was performed by Revman 5.3. Where possible, we performed the limited pooling of data.ResultsFourteen trials including a total of 1067 participants aged 65 and above were included for qualitative synthesis and meta‐analysis. The methodological quality of the included study was poor. The meta‐analysis indicated that the hip replacement group benefited more than the intramedullary nail group in terms of the bearing load time (WMD ‐14.61, 95% CI −21.51 to −7.7, P < 0.0001), mechanical complications (OR 0.34, 95% CI 0.21 to 0.57, P < 0.0001), and post‐operative complications (OR 0.46, 95% CI 0.22 to 0.93, P = 0.03). While the intramedullary nail was superior to arthroplasty regarding the intraoperative blood loss (WMD 58.36, 95% CI 30.77 to 85.94, P < 0.0001). However, there were no statistical significances in the length of surgery (WMD 5.27, 95% CI 4.23 to 14.77, P = 0.28), units of blood transfusion (WMD 0.34, 95% CI ‐0.16 to 0.85, P = 0.18), length of hospital stay (WMD ‐1.00, 95% CI ‐2.93 to 0.93, P = 0.31), Harris hip score (WMD 0.31, 95% CI ‐0.39 to 1.01, P = 0.38), and mortality (OR 1.24, 95% CI 0.12 to 13.10, P = 0.86).ConclusionsThis systematic review and meta‐analysis provided evidence for the efficacy and safety of hip replacement and intramedullary nail in treating unstable intertrochanteric fractures. However, the results should be interpreted cautiously because of methodological limitations and publication bias.

show abstract

Section: Discussionsupporting

confidence: 77%

Section: Introductionmentioning

confidence: 55%

Hip Replacement as Alternative to Intramedullary Nail in Elderly Patients with Unstable Intertrochanteric Fracture: A Systematic Review and Meta‐Analysis

Zhang

Jiang

2019

Orthopaedic Surgery

View full text Add to dashboard Cite

show abstract

“…Compared with PFN, hip arthroplasty can reduce implant-related complications and reoperation rates for intertrochanteric femoral fractures. [25] No revision surgery was performed for the BHA group in this study, but our follow-up period was too short for any strong conclusions regarding the reoperation rate. However, implant extraction was performed for 1 patient who was treated with PFN.…”

Section: Resultsmentioning

confidence: 89%

Treatment of intertrochanteric femur fractures in the elderly via bipolar hip arthroplasty or proximal femoral nail

Korkmaz¹

2018

South Clin Ist Euras

View full text Add to dashboard Cite

Objective: There is a debate about the treatment of intertrochanteric femur fractures in the geriatric population. A proximal femoral nail (PFN), a sliding hip screw, and bipolar hip arthroplasty (BHA) are the most commonly used treatment modalities. The aim of this study was to compare the blood transfusion rate, duration of surgery, and clinical scores of elderly patients treated with cementless BHA and a PFN. Methods:A total of 38 patients with intertrochanteric femur fractures treated with cementless BHA or a PFN between 2012-2016 were evaluated. In all, 20 patients had surgical treatment with cementless BHA and 18 had surgical treatment with a PFN. All of the patients were evaluated with the Harris Hip Score (HHS) at the last control visit. Blood transfusion rates and the duration of surgery were recorded and the values of both groups were compared statistically. Results:The mean HHS was 81.4±10.5 for the BHA group and 83.7±13 for the PFN group. The mean blood transfusion volume was 1.45±0.6 units for the BHA group and 0.33±0.48 units for the group treated with a PFN. The mean duration of surgery for the BHA group was 95±23.1 minutes. In the PFN group, the mean duration of the surgery was 61.8±7.3 minutes. Conclusion:There was a significant difference in the duration of surgery and the blood transfusion volume. The PFN procedure takes less time than BHA, and the blood transfusion volume is smaller. For these reasons, PFN seems to be a better option than BHA.

show abstract

“…Another meta-analysis also showed that the mortality rate within 1-year in the intramedullary xation group was reduced signi cantly compared with the AR group. 54 In addition, it has been reported that the IF group has a lower 3-year mortality rate than the AR group. 2,9 Limitations Some limitations in the present systematic review and meta-analysis should be noted.…”

Section: Mortality Within 1-yearmentioning

confidence: 99%

Arthroplasty versus internal fixation for intertrochanteric fractures in the elderly: A meta-analysis

Yu¹,

Lu²,

Xiao³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Surgical treatment is the first choice for intertrochanteric fractures in the elderly as it allows early rehabilitation and functional recovery. Recently, more and more surgeons prefer arthroplasty instead of internal fixation in the treatment of senile intertrochanteric fractures. However, there is conflicting evidence as to which is the best surgical treatment for them. In this article, we performed a systematic review and meta-analysis to compare the clinical effectiveness of internal fixation (IF) and arthroplasty (AR) for intertrochanteric fractures in the elderly. Methods The online databases of PubMed, Cochrane Database, and Web of Science were searched to include studies conducted from 01/01/2000 to 11/30/2018 in English using keywords to identify articles relevant to this study. All studies had to have evaluated the treatment of patients with intertrochanteric fractures in the elderly(≥ 60 years of age). The quality of the trials was assessed and meta-analyses were conducted using the Cochrane Collaboration’s RevMan 5.3 version. Results A total of 14 studies involving a total of 1588 patients were suitable for inclusion in this meta-analysis. There was no significant difference between the IF and AR groups for postoperative complications-related general condition (OR = 1.24; 95% CI = 0.90, 1.70; P = 0.19), hospital stay (SMD = 0.16; 95% CI= -0.5, 0.82; P = 0.64), and Harris hip score (SMD= -0.12; 95% CI= -0.79, 0.54; P = 0.71). AR group had a significantly lower rate of complications-related operation (OR = 2.21; 95% CI = 1.41, 3.45; P = 0.0005) and reoperation (OR = 2.74; 95% CI = 1.57, 4.76; P = 0.0004). However, compared with AR group, IF group could reduce the blood loss (OR=-4.08; 95% CI=-4.58, -3.59; P < 0.00001), transfusion requirement (SMD= -0.67; 95% CI= -1.08, -0.26; P = 0.001), operation time (SMD= -0.80; 95% CI= -1.47, -0.12; P < 0.00001), and have a lower rate of mortality within 1-year (OR = 0.67; 95% CI = 0.52, 0.86; P = 0.002). Conclusion AR is associated with less rates of complications-related operation and reoperation but has an increased risk of blood loss, transfusion, operation time and mortality within 1-year. Our findings demonstrated that AR does not have significant advantages over IF for intertrochanteric fractures in the elderly.

show abstract

Comparison of intramedullary fixation and arthroplasty for the treatment of intertrochanteric hip fractures in the elderly

Cited by 50 publications

References 37 publications

Hip Replacement as Alternative to Intramedullary Nail in Elderly Patients with Unstable Intertrochanteric Fracture: A Systematic Review and Meta‐Analysis

Hip Replacement as Alternative to Intramedullary Nail in Elderly Patients with Unstable Intertrochanteric Fracture: A Systematic Review and Meta‐Analysis

Treatment of intertrochanteric femur fractures in the elderly via bipolar hip arthroplasty or proximal femoral nail

Arthroplasty versus internal fixation for intertrochanteric fractures in the elderly: A meta-analysis

Contact Info

Product

Resources

About