Proximal femoral nails versus sliding hip screws in treatment of intertrochanteric fractures in adults:a systematic review

Abstract

Objective To compare the efficacy of proximal femoral nails (PFN) versus sliding hip screws (SHS) in the treatment of intertrochanteric fractures in adults. Methods According to Cochrane systematic review, Cochrane library, Medline, Embase and Chinese Biomedical Database were searched for randomized controlled trials (RCT) comparing PFN with SHS in the management of intertrochanteric fractures from 1996 to the end of June 2007. Furthermore, we also searched manually relevant references and Chinese orthopedic journals. Methodology quality of the trials was critically assessed and relative data were extracted.Statistical software Revman 4.2. 10 was used for data-analysis. Results Three RCTs and 1 quasi-RCT involving 458 cases were included. The results of meta-analysis showed that no statistically significant differences were found in the mean duration of surgery, mean intraoperative blood loss, mortality, post-operative femoral shaft fractures, lag screw cut-out, nonunion, reoperation and wound infection between PFN and SHS. Conclusions There is not enough evidence showing any obvious advantage of PFN fixation over SHS fixation in the treatment of intertrochanteric fractures in adults. Because the number of trials available for a systematic review is too small for a reliable estimate, large-scale and high-quality RCTs are needed to further determine the effects of PFN fixation versus SHS fixation. Key words: Hip fractures; Fracture fixation,internal; Systematic review