A Meta-analysis Of Intramedullary Nailing Versus Extramedullary Plate Fixation For Subtrochanteric Fractures In Adults

Objective:To compare the effectiveness and safety of intramedullary nailing versus extramedullary plate fixation for subtrochanteric fractures in adults. Methods:According to the methods of the Cochrane Systematic Review, we searched for all literature on treating subtrochanteric fractures with intramedullary nailing and extramedullary fixation by electronically searching PubMed(from1980to October2013)、Cochrane Library(Issue10,2013) EMBASE(from1980to October2013) and CBM、CNKI. The methodological quality of the included studies were evaluated. RevMan5.2.5software that the Cochrane Collaboration provided were used for a Meta-analysis to compare the effectiveness and safety between the intramedullary nailing group and extramedullary fixation group. Results:There were5studies (4RCTs and1non-randomized comparative study) brought into this research that included241patients. There were140patients treated by intramedullary nailing, and101patients by extramedullary fixation. The Meta-analysis showed that:compared to the extramedullary fixation group, the intramedullary nailing group significantly reduced the fixation failure rate[RR=0.25,95%CI (0.10,0.67), P=0.005]and nonunion rate[RR=0.17,95%CI (0.04,0.74), P=0.02].There were no statistically significant differences regarding Infection rate, femoral fracture rate, operation time and hospital stay. Conclusion:Application of intramedullary nailing in treatment of subtrochanteric fractures in adults can decrease the fixation failure and nonunion, the patients can get out of bed early.