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Review
. 2022 Aug 6:13:21514593221118212.
doi: 10.1177/21514593221118212. eCollection 2022.

Intramedullary Nail or Primary Arthroplasty? A System Review and Meta-Analysis on the Prognosis of Intertrochanteric Femoral Fractures Based on Randomized Controlled Trials

Zhaojun Wang  1 , Fei Gu  1 , Shizhuang Xu  1 , Yang Yue  1 , Kefu Sun  1 , Wei Nie  1
Affiliations
Review

Intramedullary Nail or Primary Arthroplasty? A System Review and Meta-Analysis on the Prognosis of Intertrochanteric Femoral Fractures Based on Randomized Controlled Trials

Zhaojun Wang et al. Geriatr Orthop Surg Rehabil. .

Abstract

Introduction: There is no consensus regarding the superiority between intramedullary nailing and primary arthroplasty in the management of intertrochanteric femoral fractures. This systematic review was performed to investigate and compare the clinical efficacy of intertrochanteric femoral fractures treated with these 2 methods.

Materials and methods: We systematically searched PubMed, Embase, Cochrane, Web of science core collection and ClinicalTrials.gov for randomized controlled trials which compared the clinical outcomes of intertrochanteric fractures treated with either intramedullary nails or primary arthroplasty. Relevant data of the postoperative complications, reoperations, mortality and functional assessment, were pooled and presented graphically.

Results: A total of 6 trials with 427 participants were identified and included in the analyses. The pooled estimates suggested these 2 techniques have comparable risks in terms of overall complications (pooled risk ratio [RR] .80; 95% confidence interval [CI] .43 to 1.43; I2 = 79.94%), the rate of patients with orthopedic complications (RR .71, 95% CI .40 to 1.27; I2 = .00%), reoperations (RR 1.33, 95% CI .48 to 3.71; I2 = .00%), the overall mortality (RR .52; 95%CI .26 to 1.02; I2 = 31.35%) and 1-year mortality (RR .67; 95%CI .38 to 1.19; I2 = .00%). Primary arthroplasty associated with higher HHS at 3 months postoperatively (MD -21.95, 95% CI -28.29 to -15.60; I2 = 70.44%). While the difference was not significant at 6 months (MD 2.32, 95% CI -1.55 to 6.18; I2 = .00%), and even reversed at 12 months postoperatively (MD 13.02, 95% CI 8.14 to 17.90; I2 = 73.42%).

Conclusions: Meta-analytic pooling of current evidences demonstrated that primary arthroplasty is related to a better early functional recovery at the early stage postoperatively, but the long-term result tends to favor to intramedullary nailing. The differences in overall complications, the rate of patients with orthopedic complications, reoperations, overall and 1-year mortality did not reach a significant level.

Keywords: clinical outcomes; intertrochanteric femoral fracture; intramedullary nail; meta-analysis; primary arthroplasty.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flow diagram of the literature search and selection process.
Figure 2.
Figure 2.
Pooled analysis of the rate of overall postoperative complications and patients (a) with orthopedic complications (b).
Figure 3.
Figure 3.
Pooled analysis of the rate of reoperations actually incurred (a) and that should theoretically happen (b).
Figure 4.
Figure 4.
Pooled analysis of HHS at 3rd month postoperatively (a), 6th month postoperatively (b), 12th month postoperatively (c) and pooled results of mobility score of Parker and Palmer at 12 months postoperatively (d).
Figure 5.
Figure 5.
Pooled analysis of over-all mortality (a) and 1-year mortality (b).
See this image and copyright information in PMC

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References

    1. Bhandari M, Swiontkowski M. Management of acute hip fracture. N Eng J Med. 2017;377(21):2053-2062. - PubMed
    1. Rozell JC, Hasenauer M, Donegan DJ, Neuman M. Recent advances in the treatment of hip fractures in the elderly. F1000Research. 2016;5:1953. - PMC - PubMed
    1. Tang P, Hu F, Shen J, Zhang L, Zhang L. Proximal femoral nail antirotation versus hemiarthroplasty: a study for the treatment of intertrochanteric fractures. Injury. 2012;43(6):876-881. - PubMed
    1. Yoon JY, Park S, Kim T, Im GI. Cut-out risk factor analysis after intramedullary nailing for the treatment of extracapsular fractures of the proximal femur: a retrospective study. BMC Musculoskelet Disord. 2022;23(1):107. - PMC - PubMed
    1. Morvan A, Boddaert J, Cohen-Bittan J, Picard H, Pascal-Mousselard H, Khiami F. Risk factors for cut-out after internal fixation of trochanteric fractures in elderly subjects. Orthop Traumatol Surg Res. 2018;104:1183-1187. - PubMed

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