Intramedullary Nail Versus Dynamic Hip Scew For Intertrochanteric Fracture In Adults

Objectives:To compare intramedullary nail versus dynamic hip scew forintertrochanteric fracture in adults.Search strategy:We searched the PubMed (1966～2010.6)、EMBASE (1980～2010.6)、The Cochrane Central Register of Controlled Trials (The Cochrane Library2010,Issue1), CBM (1978-2010．6)、CNKI(1994～2010)、VIP(1989～2010),and othersources.Selection criteria:All randomised and quasi-randomised controlled trials comparingintramedullary nail versus dynamic hip scew for intertrochanteric fracture.Data collection and analysis:Both authors independently assessed trial quality andextracted data. Wherever appropriate, results were pooled.Main results:We included28studies were randomized controlled trials, includedpatients with a total of3963patients,3970patients with femoral intertrochanteric fracture.The operation time, blood transfusion, the number of screw cutting the femoral head,fracture nonunion, again operation rate, deep wound infection, postoperative venousthrombosis, postoperative pulmonary embolism, anatomical outcome, pain, hip jointactivity, no significant differences in mortality. A10study compared the2methods for thetreatment of intraoperative fluoroscopy time and provides the mean and the standarddeviation. Because of the different subgroups with different time units, only a subsetanalysis. Gamma nail and dynamic hip subgroup Meta--Analysis of results: among the2groups of weighted mean difference (WMD) was1.17,95%CI-36.12~38.47, Gammanail and dynamic hip screw fixation for the treatment of femoral intertrochanteric fracturewith intraoperative fluoroscopy time no statistical difference. IMHS and dynamic hipsubgroup Meta--Analysis of results: among the2groups of weighted mean difference(WMD) was1.15,95%CI was0.83~1.47, IMHS intraoperative fluoroscopy time withdynamic hip screw fixation of long. PFN, PFNA and Holland intramedullary nail grouprespectively into1study, the results indicated that dynamic hip screw fixation for intraoperative fluoroscopy time shorter. One of the10study comparing2treatment ofoperation blood loss between the2groups, the weighted mean difference (WMD)-85.24,95%CI-156.60~-13.89, intramedullary fixation than dynamic hip screw fixationfor the treatment of femoral intertrochanteric fracture with operation less blood loss85ml.A22study reported that intraoperative femoral fractures, intramedullary fixation offemoral shaft fracture probability was higher than that of dynamic hip screw fixationgroup, a significant difference between the two groups (RR3,95%CI1.49~6.06). A23study reported postoperative femoral shaft fractures, intramedullary fixation of femoralshaft fracture after occurrence probability is significantly higher than that of dynamic hipscrew fixation group, a significant difference between the two groups (RR3.82,95%CI1.52~9.59).Authors’ conclusions:With the learning curve increased and the Gamma nail designimprovements, the femoral shaft fractures has been significantly reduced。Further studiesare required to confirm whether more recently developed designs of intramedullary nailavoid the complications of previous nails. Intramedullary nails may have advantages oversome unstable trochanteric fractures, but further studies are required.