Comparison Between Gamma Nail And DHS In Treatment Of Intertrochanteric Fracture: A Meta-analysis

Objective To asses the effects of Gamma nail and DHS(dynamic hip screw)in the treatment of intertrochanteric fractures.Methods According to the Cochrane reviewer's handbook,included studies were those on patients with histologically confirmed local advanced intertrochanteric fractures.The search strategy was developed according to the Collaborative Review Group search strategy.Medline,CBM,Cochrane library,articles in the academic degree collections were searched for clinic trails comparing efficacy of local advanced intertrochanteric fractures with Gamma nail or with DHS/Richrad nail.Trials of RCT would be assessed for quality according to the concealment of treatment allocation,blinding of patients and outcome assessors,adequate descriptions of numbers and teasons for patient withdrawl and graded their methodologic quality according to the method of Higgins.The Revman4.2 provided by the Cochrane collaboration was used to review management and analysis.The results were expressed as Relative Risk(RR)and 95% confidence internals(CI) for dischotomous outcomes.Data was pulled using fixed effect model or random effect model according to their homogeneity or heterogeneity.Chi-square tests for hetorogeneity would be performed and sensitivity analysis would be undertaken if considered appropriate.Results First I identified 102 papers on comparison of Gamma nail and DHS/Richard in the treatment of intertrochanteric fractures published from 1969—2006.8 trials involving 1682 patients were identified as meeting all the eligibility rates,wound infection,function,revision in patients with a proximal femoral fracture.4 trials,which included a total of 621 patients,provided detailed information on mortality rates over the first 6 postoperative months.I found there was no significant difference in the relative risk of death in the first 6 months postoperative between treatments of Gamma nail and those of compression hip screw.6 trials included a total of 1083 patients provided data on operative complications.The risk of operative complications from Gamma nail fixation appeared to be higher than that from compression screw and side-plate fixation but not higher than that from compression hip screw.I also found an obvious increase in the relative risk of fracture of femoral shaft between Gamma nail and compression hip screw,but there was no significant difference between the two groups.In addition,wound infection and functional recovery were similar between the two groups.Conclusions In comparison with dynamic hip screw in the treatment of intertrochanteric fractures,the Gamma nail significantly increases the risk of operative complicants,especially fracture of femoral shaft,but significantly reduces the operating time.There is no significant difference in early mortality rate,wound infection rate,operative blood loss,and postoperative function.