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

Wei Liu,Guangrong Ji,Jie Liu

doi:10.1186/s13018-020-02031-8

Wei Liu, Guangrong Ji + Show 1 more

Open Access

https://doi.org/10.1186/s13018-020-02031-8

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Abstract

BackgroundA meta-analysis to access the pros and cons of proximal femoral nail anti-rotation (PFNA) versus InterTAN nail for intertrochanteric femoral fractures including available evidence extracted from literature.MethodsAccording to the Cochrane systemic analysis method, randomized control trials (RCTs) and retrospective comparative observational studies which were related to the comparison of PFNA and InterTAN nail in the treatment of the elderly with intertrochanteric fractures were retrieved. Data were independently extracted from the included studies by two reviewers and analyzed using RevMan 5.3, and the quality of the studies was assessed.ResultsTwo RCTs and seven observational studies were recruited, which consisted of 681 patients with PFNA and 651 patients with InterTAN nail. The meta-analyses showed no significant differences between the two approaches on Harris Hip Score, operation time, blood loss, time to union, mean hospital stay, union problems, intraoperative complications, hematoma, infection, and other complications in both RCTs and observational studies. In terms of other outcomes, for the RCTs, results showed that there were shorter tip–apex distance and reduced pain at thigh or hip in InterTAN nail than in PFNA; however, InterTAN nail was not superior to PFNA in cutout, reoperation, and femoral shaft fracture; for observational studies, the risk of the screw migration (RR = 5.13, 95%CI [1.33,19.75], P = 0.02), cutout (RR = 3.26, 95%CI [1.64,6.47], P = 0.0008), the varus collapse of the femoral head (RR = 7.19, 95%CI [2.18,23.76], P = 0.001), femoral shaft fracture (RR = 5.73, 95%CI [2.24,14.65], P = 0.0003) treated by InterTAN nail were significantly decreased, compared with those by PFNA; however, no significant differences were observed in the aspects of tip–apex distance and pain at thigh or hip between these two groups.ConclusionAnalysis of a large number of relevant clinical indicators available shows that InterTAN nail has better clinical manifestation than PFNA in treating unstable femoral intertrochanteric fractures.

Highlights

A meta-analysis to access the pros and cons of proximal femoral nail anti-rotation (PFNA) versus InterTAN nail for intertrochanteric femoral fractures including available evidence extracted from literature
Inclusion and exclusion criteria All of the titles and abstracts were screened by two authors independently using the PICO framework as follows: (1) population: individuals with intertrochanteric fractures or pertrochanteric fractures; (2) intervention: PFNA; (3) comparator: InterTAN nails; (4) outcomes: Harris Hip Score (HHS), blood loss, cutout, tip–apex distance, operation time, reoperation, femoral shaft fractures, infection, intraoperative complications, length of hospital stay, hematoma, pain at thigh or hip, time to union, union problems, femoral head abnormalities, screw migration, and other complications; and (5) study design: several studies (prospective, randomized controlled trials (RCTs) or comparative observational studies published in any language) were eligible for inclusion
All randomized control trials (RCTs) were classified as unclear risk of bias since no blind methods were reported in included studies, and most observational studies were considered adequate quality based on the GRACE checklist [29]

Summary

Introduction

A meta-analysis to access the pros and cons of proximal femoral nail anti-rotation (PFNA) versus InterTAN nail for intertrochanteric femoral fractures including available evidence extracted from literature. Surgery is the mainstay of the treatment of unstable femoral intertrochanteric fractures, mainly including extramedullary fixation and intramedullary fixation. Multiple meta-analyses have shown that intramedullary fixation, compared with extramedullary fixation, could benefit the patient in terms of reduced risk of implant failure and reoperation, as well as improved functional scores [6,7,8]. PFNA is a kind of intramedullary fixation with a large area of spiral blade, which can achieve tighter bone compaction and femur alignment than traditional screws, providing optimal anchoring and stability for intertrochanteric fractures [2, 9,10,11]. InterTAN nail, as another type of intramedullary fixation, uses an integrated interlocking lag nail system that can better limit the movement of the femoral head and can effectively avoid the collapse of the femoral head [6, 12,13,14,15,16,17,18]

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