Comparative evaluation of proximal femoral nail anti-rotation versus dynamic hip screw for stable intertrochanteric femoral fractures: A meta-analysis of clinical outcomes

Abstract

In this study, a meta-analysis was conducted to compare the efficacy of proximal femoral nail anti-rotation (PFNA) and dynamic hip screw (DHS) as the treatment of stable intertrochanteric femoral fractures (AO type 31-A1). The comparison was focused on perioperative outcomes, Harris hip scores (HHSs), and major orthopedic complications. PubMed, Cochrane, ProQuest, and ScienceDirect were searched for studies comparing PFNA and DHS for stable intertrochanteric femoral fractures. The authors conducted separate screenings to determine eligible studies for this meta-analysis. The risk of bias was assessed using the Risk of Bias Tool for Randomized Trials 2 and the Risk of Bias in Non-randomized Studies–of Interventions-I. All outcomes were analyzed using Review Manager software version 5.4 and presented as forest plots. Ten studies were included in this analysis (three randomized controlled trials and seven observational studies) with 1149 patients. For the intraoperative parameters, PFNA had shorter mean operative time (mean difference [MD] −18.63, 95% interval [CI] [−27.92–−9.34], P < 0.0001) and led to less intraoperative blood loss (MD −88.84, 95% CI [−158.03–−19.65], P = 0.01). No significant differences in HHSs and complications were found between PFNA and DHS, and leg length discrepancy (risk ratio 0.40, 95% CI [0.17–0.92], P < 0.03) favoring PFNA. Overall, these two surgical methods have no meaningful differences in long-term functional outcomes and complications. The PFNA may be more beneficial in the perioperative aspect, including shorter surgical duration and lesser blood loss due to its minimally invasive nature.