Proximal femoral nail anti-rotation and locking plate for treating femoral intertrochanteric fractures: a systematic review

doi:10.3969/j.issn.2095-4344.2015.53.021

Abstract

Abstract:

BACKGROUND: Proximal femoral locking plate and proximal femoral nail anti-rotation are the two common methods for the treatment of femoral intertrochanteric fractures in clinic. However, there were few randomized controlled trials on the comparison of both methods. Most of them are retrospective case analysis, and short of systematic evaluation.

OBJECTIVE: To systematically evaluate the clinical outcomes and safety between locking compression plate and proximal femoral nail anti-rotation for the treatment of the femoral intertrochanteric fractures.

METHODS: The Cochrane Library (No.2 in 2015), PubMed(1966-01/2015-06), MEDLINE (1966-01/2015-06), EMbase (1984-01/2015-06), CNKI (1979-01/2015-06), VIP(1989-01/2015-06)and WanFang Data(1990-2015)were searched by computer. Meanwhile, relevant literature from the relevant journals and references were searched by hand. All the randomized controlled trials concerning locking compression plate

and proximal femoral nail anti-rotation for the treatment of the femoral intertrochanteric fractures were collected. The literature was strictly filtered out according to the inclusion criteria, and was strictly evaluated for the quality. Meta-analysis on the included results was performed with RevMan5.2 software from the Cochrane collaboration.

RESULTS AND CONCLUSION: There were 54 potentially relevant papers, and finally, 11 randomized controlled trials were eligible for this investigation. A total of 917 patients were included containing locking compression plate group (464 cases), proximal femoral nail anti-rotation group (453 cases). The Meta-analysis results showed that there were no significant differences in Harris scores, excellent rate, complications, fracture healing time and hospital stays after treatment between the locking compression plate and proximal femoral nail anti-rotation groups. However, there were significant differences in the time of operation [MD=15.80，95% CI(7.57-24.04), P =0.000 2], peri-operative blood loss [MD=98.01, 95% CI(58.57-137.44)，P < 0.01], ambulation loading time [MD=8.07，95% CI(3.02-13.12)，P=0.002], the length of incision [MD=6.90，95% CI(1.07-12.73), P=0.02] and postoperative drainage volume [MD=41.85，95% CI(23.77-59.93)，P < 0.01]. These results suggest that the treatment of proximal femoral nail anti-rotation had shortened the length of incision and the time of operation. The treatment of locking compression plate took more time of ambulation loading time, more peri-operative blood loss and postoperative drainage volume. Because the number of cases which this study included are few, and the follow-up time was shorter, we should design stricter large sample randomized controlled studies in future increase the strength of the evidence by conducting medium and long-term follow-up.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

CLC Number:

R318

Wang Feng, Li Zhen-wu, Yin Rui-feng, Li Zhi-an. Proximal femoral nail anti-rotation and locking plate for treating femoral intertrochanteric fractures: a systematic review[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(53): 8677-8684.

Figures/Tables 13

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