Comparing Intramedullary Nails versus Dynamic Hip Screws in the Treatment of Intertrochanteric Hip Fractures on Post-operative Rehabilitation Outcomes - A Systematic Review and Meta-Analysis

Abstract

Objective: We conducted a systematic review and meta-analysis to compare post-operative rehabilitation outcomes between two common treatments in patients who have suffered an intertrochanteric hip fracture: intramedullary nails vs dynamic hip screws.

Methods: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science up to August 10, 2022. The inclusion criteria were defined as Population: adults (>18 years old); Interventions/Comparators: intramedullary nails and dynamic hip screws; Outcomes: function, quality of life and survival; and Study type: randomized controlled trials and non-randomized studies. A meta-analysis was performed, and the fixed-effect model was selected to pool the data for homogeneous studies (I² < 50%) and the random effect model was selected for heterogeneity I²>50%. The P-value of less than 0.05 was considered statistically significant. A narrative synthesis was conducted on the remaining outcomes with insufficient data (ie, missing means, or standard deviations).

Results: 108 studies were included in the review. 42 studies had outcomes that were included in the meta-analysis. There were modest differences after sensitivity analysis for the Parker mobility score mean difference (MD) = 0.70, 95% CI [0.12, 1.28], T = 3.11, df = 5, P = 0.03, and Harris hip score (MD = 0.94, 95% CI [0.34, 1.54], T = 3.54, df = 9, P = 0.006) favoring the nails. There were no statistically significant differences in the Functional Independence Measure (FIM) (MD = -2.50, 95% CI [-6.46, 1.45], Z = 1.24, P = 0.22), the Barthel Index (MD = 2.66, 95% CI [-7.60, 12.92], T = 1,12, df = 2, P = 0.38), the generic quality of life (MD = 0.04, 95% CI [-0.08, 0.17], Z = 0.70, P = 0.49), the health-related quality of life (MD = -0.14, 95% CI [-3.57, 3.28], Z = 0.08, P = 0.93) or mortality (1.00, 95% CI [0.96, 1.03], Z = 0.16, P = 0.87) outcomes.

Conclusion: This review showed some differences in functional outcomes in the treatment of intertrochanteric fractures favoring intramedullary nails over dynamic hip screws. There were no differences between the groups for quality of life and mortality outcomes. The narrative synthesis showed additional outcomes that warrant further investigations.

Keywords: dynamic implants; functional outcomes; hip fracture; intertrochanteric hip fracture; intramedullary nails; rehabilitation.

Figure 1.

PRISMA Flowchart

Figure 2.

(A) Risk of Bias Summary for RCTs, (B) Risk of Bias for Non-randomized studies

Figure 3.

Forest Plots. (A) Functional Independence Measure (FIM) score, (B) Barthel Index, (C) Parker Mobility Score, (D) Harris Hip Score, (E) Generic Quality of Life (EQ-5D), (F) Health-related Quality of Life (Short Form-12 Physical Component Summary)