Functional outcomes of internal fixation and arthroplasty in the treatment of intertrochanteric femoral fractures: a systematic review

Abstract

Background: Hip fractures are a common cause of morbidity, especially in the elderly. Treatment of extracapsular hip fractures is highly controversial. Fixation is the main treatment for this type of fracture including extramedullary and intramedullary fixation. The problem of fixation failure remains the main drawback. Many trials have shown that arthroplasty as an alternative option would have better functional results, especially in the early postoperative period. The aim of this review was to compare the functional outcomes of internal fixation versus arthroplasty in the treatment of intertrochanteric fractures. Methods: Two reviewers searched the following databases: PubMed, the Cochrane Library, Ovid, and Science Direct for randomized control trials (RCTs) and quasi-random trials comparing the outcomes of internal fixation and arthroplasty in the treatment of intertrochanteric fractures. We assessed the quality of the studies meeting the eligibility criteria by using the Cochrane assessment tool. For measuring the outcomes, we used the mean difference with 95% confidence interval for continuous data and risk difference, with 95% confidence interval for dichotomous data. Results: The electronic search revealed 3402 citations. After removing duplicate articles, 3397 citations were screened for possible inclusion in the review. Of those 3273 citations were excluded by title or abstract. One hundred and twenty-four full text articles were assessed for eligibility. Six studies compared the results of fixation versus arthroplasty. A meta-analysis of the studies showed no difference in mean Harris Hip Score between groups (mean difference −7.51 [−12.28, −2.74). There was also no difference in the independence of ambulation at 1 yr (risk difference 0.01 [−0.17, 0.19]). The cost of treatment was higher in the arthroplasty group (mean difference 5898.00 [5364.00, 6432.00]). There was no difference in reoperation (risk difference −0.09 [−0.15, −0.03]) and mortality risks (risk difference −0.10 [−0.32, 0.12]). Conclusions: Although most patients with intertrochanteric fracture are treated successfully with internal fixation, arthroplasty could be useful in certain types of fractures. However, there is a lack of high-quality evidence to assist surgeons in deciding when to use this option.

A comparison of hemiarthroplasty versus dynamic hip screw fixation for intertrochanteric femoral fractures: a systematic review

“…6,10–12 2 previous systematic reviews have compared arthroplasty with internal fixation. 13,14 However, in these reports, numerous fixation methods were grouped and analysed together, as were total hip arthroplasties with hemiarthroplasties. A review has yet to be produced comparing hemiarthroplasty with DHS fixation alone for these fractures.…”