Chinese Journal of Tissue Engineering Research ›› 2012, Vol. 16 ›› Issue (48): 9002-9009.doi: 10.3969/j.issn.2095-4344.2012.48.014

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Meta analysis on intertrochanteric fractures in adults treated with proximal femoral nail anti-rotation and common intramedullary fixation

Lei Guang-hua1, Zeng Chao1, Wei Jie2, Gao Shu-guang1, Sun Zhen-qiu2, Wang Yi-ren2   

  1. 1Department of Orthopedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
    2School of Public Health, Central South University, Changsha 410008, Hunan Province, China
  • Received:2012-09-08 Revised:2012-09-15 Online:2012-11-25 Published:2013-03-14
  • Contact: Wang Yi-ren, Doctor, Lecturer, School of Public Health, Central South University, Changsha 410008, Hunan Province, China 125562108@qq.com
  • About author:Lei Guang-hua☆, Doctor, Professor, Doctoral Supervisor, Department of Orthopedics, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China zengchao19880505@sina.com

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Abstract:

BACKGROUND: At present, the treatment of intertrochanteric fractures is mainly depending on extramedullary fixation and intramedullary fixation. Theoretically, the intramedullary fixation has the better stability and fewer complications. However, the emergence and existence of a large number of different types of fixtures demonstrate that these internal fixations have certain defects and deficiencies.
OBJECTIVE: To compare the efficacy of proximal femoral nail anti-rotation versus other two common intramedullary fixations (proximal femoral nail and Gamma nail) in the treatment of intertrochanteric fractures in adults.
METHODS: A computer-based search was performed on Cochrane library, Medline database, Elsevier database, Chinese Biomedical Database and Wanfang database for randomized controlled trials or non-randomized controlled trials on comparison between proximal femoral nail anti-rotation and proximal femoral nail, proximal femoral nail anti-rotation and Gamma nail fixation in the treatment of intertrochanteric fractures which were reported before 5 December 2011. Methodology quality of the trials was critically assessed and relative data were extracted.
RESULTS AND CONCLUSION: A total of 5 randomized controlled trials and 13 non-randomized controlled trials involving 2 185 cases were included, 1 013 cases in proximal femoral nail anti-rotation group, 658 cases in proximal femoral nail group and 514 cases in Gamma nail fixation group. The results of meta-analysis showed that proximal femoral nail anti-rotation could significantly decrease the mean duration of surgery and mean intraoperative blood loss compared with proximal femoral nail. However, no insufficient evidence demonstrated that proximal femoral nail anti-rotation was better than proximal femoral nail in the rate of postoperative complication and the excellent and good rate of Harris score. It also showed that proximal femoral nail anti-rotation could significantly decrease the mean duration of surgery and mean intraoperative blood loss when compared with Gamma nail. However, there were no statistic differences in the mean duration of hospital, mean duration of fracture healing, the rate of postoperative complication and the excellent and good rate of Harris score between proximal femoral nail anti-rotation and Gamma nail treatment.

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