Systematic review of dynamic hip plate and proximal femoral intramedullary nail fixation for intertrochanteric fracture in adults / 中国组织工程研究

ABSTRACT

BACKGROUND:Intertrochanteric fractures are often treated with extramedulary fixation and intramedulary fixation. Which internal fixation can better repair intertrochanteric fractures remains controversial. OBJECTIVE: To compare the efficacy and safety of dynamic hip plate and proximal femoral intramedulary nail fixation in treatment of intertrochanteric fracture in adults. METHODS: Al randomized clinical trials relevant to comparing proximal femoral intramedulary nail fixation with dynamic hip plate for intertrochanteric fracture in adults from 1966 to 2013 were identified. The quality of the trials was assessed. The outcomes included length of surgery, operative blood loss, postoperative femoral shaft fracture, cut-out of the implant from the femoral head, non-union of the fracture, reoperation rate, wound infection, postoperative hip pain (hip joint pain and thigh pain), which were extracted and reviewed systematicaly. RESULTS AND CONCLUSION:4 757 trial participants with 4 748 fractures were included in the 31 published trials. There was no significant difference in the length of surgery, reoperation rate, cut-out of the implant from the femoral head, non-union of the fracture, wound infection and postoperative hip pain between the two groups (P > 0.05) between dynamic hip plate and proximal femoral intramedulary nail fixation. Compared with dynamic hip plate fixation, proximal femoral intramedulary nail fixation had less blood loss and significantly higher rate of femoral shaft fractures (P=0.003). Experimental findings show that, in treatment of intertrochanteric fracture, intramedulary nail fixation is associated with significantly lower blood loss. However, the risk of femoral shaft fracture is increased compared with dynamic plate fixation. There were no differences in length of surgery, cut-out of the implant from the femoral head, non-union of the fracture, reoperation rate, wound infection and postoperative hip pain. The results of this systematic review should be explained prudently because of some limitations of included trials. To obtain more reliable conclusions, large-scale randomized controled trials of strict design, uniform index and long-term folow-up are needed.