[Proximal femoral nail antirotation versus dynamic hip screw for intertrochanteric fracture in elders: a meta-analysis].

OBJECTIVE

To assess the efficacies of proximal femoral nail antirotation (PFNA) versus dynamic hip screw (DHS) for intertrochanteric fracture in elders.

METHODS

The databases of PubMed, Embase, CENTRAL, CBM, CNKI and WANFANG were searched for the relevant randomized controlled trials (RCTs) up to May 18, 2013. After quality evaluation and data extraction by two authors independently, meta-analyses were performed with the RevMan5.1 software. And the levels of evidence were evaluated by the GRADEprofile 3.6 software.

RESULTS

A total of 17 studies (n = 1 344) were included and there were 656 patients in PFNA group and 688 in DHS respectively. Meta-analyses showed that, as compared with DHS, PFNA could significantly decrease fixation failure rate (odds ratio (OR) = 0.26, 95% confidence interval (CI) = [0.12, 0.57], P = 0.0008), reduce average fracture healing time (weighted mean difference (WMD) = -15.11, 95%CI = [-24.36, -5.85], P = 0.001), improve excellent and good rate for Harris score (OR = 0.29, 95%CI = [0.15, 0.56], P = 0.0002), yield a higher Harris score (WMD = 6.88, 95%CI = [0.96, 12.80], P = 0.02) and reduce the rate of coxa vara (OR = 0.40, 95%CI = [0.18,0.92], P = 0.03). However, there was no statistical significance in 1-year mortality, postoperative nonunion and delayed union, postoperative femoral head necrosis, postoperative femoral fractures or femoral head necrosis. The importance of outcomes was "critical". And the level of evidences based on the GRADE approach was from "very low" to "low".

CONCLUSION

PFNA is superior to DHS. Due to the limitations of the included studies, more large-sample and high-quality RCTs are required. And subgroup analysis based on fracture types should be performed.