Comparing surgical interventions for intertrochanteric hip fracture by blood loss and operation time: a network meta-analysis

Abstract

Background: Multiple operative treatments are available for the fixation of intertrochanteric femoral fractures. This analysis was conducted to provide guidance on the appropriate clinical choice to accommodate individual patients.

Methods: A systematic review was performed to identify relevant articles in databases. Randomized controlled trials (RCTs) of adults with intertrochanteric femoral fractures were eligible if they compared 2 or more of the following interventions: proximal femoral nail anti-rotation (PFNA), percutaneous compression plate (PCCP) use, dynamic hip screw (DHS) fixation, gamma nail (GN) fixation, and artificial femoral head replacement (FHR). Bayesian network meta-analysis was performed to simultaneously compare all treatment methods.

Results: In total, 24 active-comparator studies involving 3097 participants were identified. Across all populations, greater reductions in blood loss and operation time were observed for PFNA than for other treatments. In terms of bleeding, more blood loss was observed for DHS use than for the PFNA (SMD, 1.96; 95% CI, 1.01-1.96), PCCP (SMD, 1.26; 95% CI, 0.31-2.20), and GN (SMD, 0.26; 95% CI, - 0.35-0.87) techniques. However, a more beneficial effect was observed for DHS use than for FHR (SMD, - 0.23; 95% CI, - 1.26-0.81). DHS use resulted in a significantly longer duration of operation time than the PFNA (SMD, 0.75; 95% CI, - 0.02-0.75), PCCP (SMD, 0.61; 95% CI, - 0.20-1.44), and GN (SMD, 0.25; 95% CI, - 0.26-0.77) techniques. Similarly, greater reductions in operation time were observed for DHS use than for FHR (SMD, - 0.12; 95% CI, - 1.15-0.91).

Conclusions: The findings provide supporting evidence demonstrating the superiority of PFNA over other treatments for intertrochanteric femoral fracture. PFNA treatment results in the lowest amount of blood loss and the shortest operation time. These findings add to the existing knowledge of intertrochanteric femoral fracture treatment options.

Keywords: Intertrochanteric hip fracture; Meta-analysis; Surgical intervention.

Fig. 1

Flowchart of the study selection process

Fig. 2

The eligible clinical trials included in the network meta-analysis. The width of the connecting lines is proportional to the number of available head-to-head (direct) comparisons. The size of each node is proportional to the number of randomly assigned participants (sample size)

Fig. 3

Ranking probability curves for blood loss during the operation. The graph displays the distribution of probabilities for each treatment. The X-axis represents the rank, and the Y-axis represents probabilities. The ranking indicates the probability that a particular treatment is the “best,” “second best,” etc

Fig. 4

Ranking probability curves for operation time. The graph displays the distribution of probabilities for each treatment. The X-axis represents the rank, and the Y-axis represents probabilities. The ranking indicates the probability that a particular treatment is the “best,” “second best,” etc