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Meta-Analysis
. 2022 Jun 3;17(1):292.
doi: 10.1186/s13018-022-03189-z.

Comparative effectiveness research on proximal femoral nail versus dynamic hip screw in patients with trochanteric fractures: a systematic review and meta-analysis of randomized trials

Hong Xu #  1 , Yang Liu #  2 , Erdem Aras Sezgin  3 , Šarūnas Tarasevičius  4 , Robin Christensen  5   6 , Deepak Bushan Raina  2 , Magnus Tägil  2 , Lars Lidgren  2
Affiliations
Meta-Analysis

Comparative effectiveness research on proximal femoral nail versus dynamic hip screw in patients with trochanteric fractures: a systematic review and meta-analysis of randomized trials

Hong Xu et al. J Orthop Surg Res. .

Abstract

Background: The treatments for trochanteric fractures try to regain early mobility and limit morbidity and risk of reoperations. The most currently used dynamic hip screw (DHS) and the proximal femoral nail (PFN) are both with pros and cons. We aimed to assess the comparative effectiveness of these interventions for trochanteric fractures by evaluating the surgical performance and postoperative outcomes.

Methods: PubMed, Web of Science and Cochrane Central Register were searched for RCTs comparing DHS and PFN for trochanteric fractures. All selected studies and the risk of bias were assessed. Clinical data including operative time, intraoperative blood loss, intraoperative fluoroscopy time, successful closed reduction and complications like nonunion, implant failure and reoperation were recorded. Random-effects models were used in Review Manager software, and GRADE was applied for the interpretation of the evidence.

Results: From 286 identified trials, twelve RCTs including 1889 patients were eligible for inclusion; six RCTs directly comparing DHS with PFN, while other six compared DHS with proximal femoral nail antirotation (PFNA). Compared to DHS, PFN had shorter operative time and led to less intraoperative blood loss. However, DHS need less intraoperative fluoroscopy time than PFN. No difference was seen for the achievement of closed reduction. For risk of postoperative complications, no difference was seen between PFN and DHS for non-union, risk of implant failure and revision surgery.

Conclusions: PFN(A) resulted in a shorter operative time and less intraoperative blood loss compared to DHS. However, no difference was seen for postoperative complications. Trial registration PROSPERO: CRD42021239974.

Keywords: Dynamic hip screw; Implant failure; Meta-Analysis; Proximal femur screw; Revision surgery; Trochanteric fractures.

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Conflict of interest statement

LL is a board member of BoneSupport AB, Sweden and OrthoCell, Australia. LL, MT and DBR hold stocks in Moroxite AB, Sweden. All other authors have no conflicts of interest to disclose in relation to this article.

Figures

Fig. 1
Fig. 1
Flow diagram of the systematic literature search and selection of included studies.
Fig. 2
Fig. 2
Risk of bias of included trials.
See this image and copyright information in PMC

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