Antirotation proximal femoral nail versus dynamic hip screw for intertrochanteric fractures: a meta-analysis of randomized controlled studies.

BACKGROUND: Previous studies comparing proximal femoral nail antirotation (PFNA) with dynamic hip screw (DHS) for peritrochanteric fractures reported conflicting findings. The objective of this meta-analysis was to compare the efficacy and safety of PFNA and DHS for pertrochanteric fractures.

HYPOTHESIS: PFNA achieves better efficacy for peritrochanteric fractures compared with DHS.

MATERIALS AND METHODS: Relevant randomized controlled trials comparing PFNA with DHS for pertrochanteric fractures were assessed for eligibility and included into this meta-analysis. Data were extracted independently and methodological quality was further assessed. The inclusion criteria of this meta-analysis were: randomized controlled trials comparing PFNA with DHS for pertrochanteric fractures and reporting at least one of these main outcomes, including operating time, blood loss, all causes mortality, and complications.

RESULTS: Five randomized controlled trials were finally included into this meta-analysis. Pooled results showed there were less blood loss (weighted mean difference Blood loss=-249.75ml, 95%CI -303.83 to -195.67, P<0.0001) and fewer complications (Odds ratio=0.40, 95%CI 0.23 to 0.70, P=0.001) in the PFNA group compared with the DHS group. However, there was no difference in term of mortality between those two groups (Odds ratio mortality=1.13, 95%CI 0.47 to 2.69, P=0.79). Sensitivity analysis by sequential omission of individual studies showed that the significance of pooled odds ratios was robust, which suggested this outcome was credible.

DISCUSSION: PFNA can benefit peritrochanteric fractures patients with less blood loss and fewer complications compared with DHS. The significant heterogeneity among the included trials for intraoperative blood loss, and operation time may be attributable to variation in the skills of the surgeons and the different types of perirochanteric fractures. In addition, more powered randomized studies are needed to identify the findings from this meta-analysis, and the effects of long-term follow-up also need further study, especially the impact on the mortality.

LEVEL OF EVIDENCE: Level II, meta-analysis of low powered randomized study.