Comparison of effects of four treatment methods for unstable intertrochanteric fractures: A network meta-analysis

Abstract

Purpose: The optimal internal fixation device for unstable intertrochanteric fracture remains a matter of controversy. By performing network meta-analysis, we developed a ranking of the following four surgical methods: proximal femoral nail antirotation, InterTan nail, gamma nail (GN) and sliding hip screws. We compare the complication rates in patients with unstable intertrochanteric fractures.

Materials and methods: After an exhaustive search of MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials for relevant studies, randomized controlled trials meeting selection criteria were entered into our network meta-analysis. Statistical analyses were conducted using Stata software, version 13.0 (Stata Corporation, College Station, Texas, USA).

Results: We included 12 randomized controlled trials. Compared to Sliding hip screw, there were no substantial differences in rates of complications in unstable intertrochanteric fractures patient undergoing various treatments (all p > 0.05). Nevertheless, the surface under the cumulative ranking curve (SUCRA) for GN (80.6%) was significantly higher than those of the other three methods.

Conclusion: GN had the highest probability of reducing the total incidence of complications among the four interventions for treating unstable intertrochanteric fractures.

Keywords: Gamma nail; InterTan nail; Network meta-analysis; Proximal femoral nail antirotation; Sliding hip screws; Unstable femoral intertrochanteric fractures.