Abstract
Treatment options for unstable intertrochanteric fractures include intramedullary nail and extramedullary fixation, although evidence regarding the most appropriate treatment for such fractures remains controversial. Our hypothesis was that there would be no obvious differences in mortality rates, functional outcomes and complications between the two groups. We therefore conducted a meta-analysis to compare the relative advantages of intramedullary nail and extramedullary fixation. A total of 10 randomized controlled trials including only patients with unstable intertrochanteric fractures were included in the final analysis. We found that no statistically significant difference in one-year mortality was observed between the two groups (RR: 0.78, 95% CI: 0.55–1.10, p = 0.160). Analysis of exact p values from five included studies indicated that functional outcomes were markedly better for patients of the intramedullary nail group when compared with those of the extramedullary fixation group (p = 0.0028), although evidence remains controversial. Higher incidences of all complications were noted for extramedullary fixation (RR:1.48, 95% CI: 1.12–1.96, p = 0.006). However, no significant differences in implant-related complications were observed between the two groups (RR:1.20, 95% CI: 0.73–1.97, p = 0.475). Therefore, comparing with extramedullary fixation, the intramedullary nail method would be more reliable and should be encouraging for unstable intertrochanteric fractures.
Highlights
Seven primary functional scoring systems were utilized among the 10 included studies: Lower Extremity Measure (LEM), Salvati and Wilson Scoring System (SWS), Ambulatory status and Living situation, Harris Hip Score (HHS), Walking ability, EuroQol 5D, Mobility score
Functional outcomes were markedly better in the extramedullary fixation group than in the intramedullary nail group in three studies[16,18,22]
Several fixation devices have been developed to overcome the difficulties encountered in the treatment of such fractures, including extramedullary (DHS, CHS, PFLCP, AMBI, SHS) and intramedullary (ITN, PFNA, GN) devices[28]
Summary
We conducted a meta-analysis of 10 randomized controlled trials involving only patients with unstable intertrochanteric fractures in order to compare mortality rates, functional outcomes and complications between intramedullary Nail and extramedullary fixation procedures, and our hypothesis was that there would be no obvious differences in mortality rates, functional outcomes and complications between the two groups. The χ2 tests, I2 tests, and L’Abbé plots of complications indicated no obvious heterogeneity among the included studies (χ2 = 11.36, P = 0.252, I2 = 20.8%, Fig. 4A), so a fixed-effects model was used for the analysis.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
