Comparative effectiveness research on proximal femoral nail versus dynamic hip screw in patients with trochanteric fractures: a systematic review and meta-analysis of randomized trials

• Published in: Journal of orthopaedic surgery and research 2022-06, Vol.17 (1), p.292-11, Article 292
• Main Authors: Xu, Hong, Liu, Yang, Sezgin, Erdem Aras, Tarasevičius, Šarūnas, Christensen, Robin, Raina, Deepak Bushan, Tägil, Magnus, Lidgren, Lars
• Format: Article
• Language: English
• Subjects: Analysis; Bias; Blood; Blood Loss, Surgical - prevention & control; Bone Nails; Bone Screws; Clinical Medicine; Clinical outcomes; Clinical trials; Closed reduction; Comparative Effectiveness Research; Complications; Dynamic hip screw; Femur; Fluoroscopy; Fracture Fixation, Internal - methods; Fracture Fixation, Intramedullary - methods; Fractures; Hip; Hip Fractures - surgery; Humans; Implant failure; Internal fixation in fractures; Klinisk medicin; Medical and Health Sciences; Medicin och hälsovetenskap; Meta-Analysis; Morbidity; Nonunion; Older people; Orthopedics; Ortopedi; Patients; Postoperative; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Proximal femur screw; Randomized Controlled Trials as Topic; Revision surgery; Systematic Review; Treatment Outcome; Trochanteric fractures
• ISSN: 1749-799X; 1749-799X
• DOI: 10.1186/s13018-022-03189-z

The treatments for trochanteric fractures try to regain early mobility and limit morbidity and risk of reoperations. The most currently used dynamic hip screw (DHS) and the proximal femoral nail (PFN) are both with pros and cons. We aimed to assess the comparative effectiveness of these interventions for trochanteric fractures by evaluating the surgical performance and postoperative outcomes. PubMed, Web of Science and Cochrane Central Register were searched for RCTs comparing DHS and PFN for trochanteric fractures. All selected studies and the risk of bias were assessed. Clinical data including operative time, intraoperative blood loss, intraoperative fluoroscopy time, successful closed reduction and complications like nonunion, implant failure and reoperation were recorded. Random-effects models were used in Review Manager software, and GRADE was applied for the interpretation of the evidence. From 286 identified trials, twelve RCTs including 1889 patients were eligible for inclusion; six RCTs directly comparing DHS with PFN, while other six compared DHS with proximal femoral nail antirotation (PFNA). Compared to DHS, PFN had shorter operative time and led to less intraoperative blood loss. However, DHS need less intraoperative fluoroscopy time than PFN. No difference was seen for the achievement of closed reduction. For risk of postoperative complications, no difference was seen between PFN and DHS for non-union, risk of implant failure and revision surgery. PFN(A) resulted in a shorter operative time and less intraoperative blood loss compared to DHS. However, no difference was seen for postoperative complications. Trial registration PROSPERO: CRD42021239974.