Minimally invasive versus conventional dynamic hip screw for intertrochanteric fractures in the aged:a Meta-analysis

Abstract

Objective To compare minimally invasive dynamic hip screw(MIDHS)and conventional dynamic hip screw(CDHS)in the treatment of intertrochanteric fractures in the aged by a comprehensive meta-analysis.Methods The literature on treating intertrochanteric fractures with M1DHS and CDHS via PubMed(from 1966 to May 2011),EMBASE(from 1980 to May 2011),Cochrane library,CNKI(from 1994 to May 2011)and Wanfang database(from 1993 to May 2011)were collected.The rate of postoperative serious complication,operation time,haemoglobin decrease,healing time,and postoperative Harris hip score were the outcomes of interest.Meta-analysis and forest plots were conducted with RevMan5.0 software.Results Ten studies involving 769 fractures were included which compared the effects of the MIDHS and CDHS.The results showed a lower rate of postoperative serious complication with the MIDHS compared to the CDHS[relative risk(RR):0.30,95％ confidence interval(CI)0.18 to 0.49,P ＜ 0.001].The average operating time[weighted mean difference(WMD)=-21.47,95％ CI-31.95 to-10.99,P ＜0.001],haemoglobin decrease(WMD=-1.44,95％ CI-1.98 to-0.89,P ＜ 0.001),and the healing time(WMD =-0.74,95％ CI-1.16 to-0.33,P ＜ 0.001)also appeared to be decreased with the use of MIDHS,and the postoperative Harris hip score(WMD =1.60,95％ CI 0.68 to 2.53,P ＜0.001)was higher in the MIDHS fixation.Conclusion In the treatment of intertrochanteric fractures for the elderly patients,the MIDHS fixation is superior to the CDHS fixation due to its advantages of shorter operating time,less blood loss,fewer postoperative serious complications,faster fracture healing and better functional recovery. Key words: Hip fractures; Fracture fixation, internal; Bone nails; Surgical procedures; minimally invasive; Meta-analysis