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Review
. 2021 Jan 11;16(1):47.
doi: 10.1186/s13018-020-02193-5.

Cephalo-medullary nailing versus dynamic hip screw with trochanteric stabilisation plate for the treatment of unstable per-trochanteric hip fractures: a meta-analysis

Amr Selim  1   2 , Nikhil Ponugoti  3 , Ali Zain Naqvi  3 , Henry Magill  4
Affiliations
Review

Cephalo-medullary nailing versus dynamic hip screw with trochanteric stabilisation plate for the treatment of unstable per-trochanteric hip fractures: a meta-analysis

Amr Selim et al. J Orthop Surg Res. .

Abstract

Background: The use of cephalo-medullary nails (CMN) is a widely accepted management option for the treatment of unstable per-trochanteric hip fractures. A growing body of literature has reported good functional and radiological outcomes in patients managed with a dynamic hip screw supplemented with a trochanteric stabilisation plate (DHS w/ TSP). However, a robust meta-analysis does not exist in the current literature comparing the two fixation methods.

Purposes: Management of these kinds of injuries is very challenging in orthopaedic practice, yet no strong evidence is in place to delineate which implant gives the best results. This meta-analysis is the first to determine the efficacy of CMN versus DHS w/ TSP.

Methods: An up-to-date literature search was performed using a predetermined search strategy and eligibility criteria. All suitable literature was appraised for methodological quality using the Cochrane's collaboration tool. Hospital stay, operative time, intra-operative complication rate, mechanical failure rate, infection rates, revision rates and functional outcomes were all considered.

Results: A total of five studies were included in the meta-analysis. The results of this analysis suggest that CMN is only associated with lower revision rates when compared to DHS w/ TSP; however, no significant difference was found in terms of hospital stay, operative time, blood transfusion, complications rate and functional outcome.

Conclusion: Both CMN and DHS w/TSP proved to be reliable in the management of unstable per-trochanteric fractures; however, more extensive datasets are required to draw robust conclusions.

Keywords: Cephalo-medullary nail; Dynamic hip screw; Hip fractures; Trochanteric stabilisation plate; Unstable trochanteric fractures.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The Preferred Reporting Items for Systematic Reviews and Meta-Analysis
Fig. 2
Fig. 2
A figure displaying the risk of bias for the RCT included in the meta-analysis. Each colour represents the risk of bias in each of the domains (red = high risk, yellow = unclear and green = low risk)
Fig. 3
Fig. 3
A forest plot showing the comparison of a hospital stay (days), b operative time (minutes) and c blood transfusion (units) between the two fixation methods. CI, confidence interval; IV, independent variable; M-H Mantel-Haenszel; CMN, cephalo-medullary nail; DHS, dynamic hip screw; TSP, trochanteric stabilisation plate
Fig. 4
Fig. 4
A forest plot showing the comparison of a hospital stay (days), b mechanical failure rates and c infection rates between the two fixation methods. CI, confidence interval; IV, independent variable; M-H, Mantel-Haenszel; CMN, cephalo-medullary nail; DHS, dynamic hip screw; TSP, trochanteric stabilisation plate
Fig. 5
Fig. 5
A forest plot showing the comparison of a revision rates, b “good” functional outcomes and c “poor” functional outcomes between the two fixation methods. CI, confidence interval; IV, independent variable; M-H, Mantel-Haenszel; CMN, cephalo-medullary nail; DHS, dynamic hip screw; TSP, trochanteric stabilisation plate
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