Internal fixation treatments for intertrochanteric fracture: a systematic review and meta-analysis of randomized evidence

Abstract

The relative effects of internal fixation strategies for intertrochanteric fracture after operation remain uncertain. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to address this important issue. We searched PubMed, EMBASE and CENTRAL for RCTs that compared different internal fixation implants in patients with intertrochanteric fracture at 6-month follow-up or longer. We ultimately included 43 trials enrolling 6911 patients; most trials were small in sample sizes and events. Their risk of bias was generally unclear due to insufficient reporting. Because of these, no statistically significant differences were present from most of the comparisons across all the outcomes, and no definitive conclusions can be made. However, a number of trials compared two commonly used internal fixation strategies, gamma nail (GN) and sliding hip screw (SHS). There is good evidence suggesting that, compared to SHS, GN may increase the risk of cut out (OR = 1.87, 95% CI, 1.08 to 3.21), re-operation (OR = 1.61, 95% CI, 1.02 to 2.53), intra-operative (OR = 3.14, 95% CI, 1.34 to 7.35) and later fractures (OR = 3.67, 95% CI, 1.37 to 9.83). Future randomized trials or observational studies that are carefully designed and conducted are warranted to establish the effects of alternative internal fixation strategies for intertrochanteric fracture.

Comparison of clinical outcomes with proximal femoral nail anti-rotation versus InterTAN nail for intertrochanteric femoral fractures: A meta-analysis

“…Postoperative pain is an element that affects patients' quality of life. Screw failure, femoral shaft fracture, and other implant failure-related complications may lead to long-term pain [35]. The results of the present analysis results are consistent with the findings of the above research.…”

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

“…Yu et al . included 29 trials reporting cutout data in their meta‐analysis . The pooling of the trials showed gama nail increased the risk of cutout compared to sliding hip screw, and no significant differences were found in PFN or PFNA comparisons.…”

A novel three-dimensional classification system for intertrochanteric fractures based on computed tomography findings

“…Intertrochanteric fragility fractures are common in the elderly population and are becoming increasingly frequent with continued aging of populations worldwide (14). Intertrochanteric fractures are usually treated by osteosynthesis, which includes intramedullary and extramedullary fixation (2,15). However, elderly individuals have poor bone quality, so intertrochanteric fractures in the elderly are likely to be unstable.…”

“…The number of intertrochanteric fractures in the elderly population has been increasing worldwide because of increasing life expectancy (1). Osteosynthesis has been widely used for intertrochanteric fractures (2). However, it is not always possible for elderly patients with unstable fractures to have good outcomes after osteosynthesis (3,4).…”