Intramedullary versus extramedullary internal fixation for unstable intertrochanteric fracture, a meta-analysis.

OBJECTIVE

The aim of this meta-analysis was to explore the difference between and compare intramedullary fixation (IF) and extramedullary fixation (EF) for unstable intertrochanteric fractures.

METHODS

We searched Pubmed database and Cochrane library following by including and excluding articles based from inception to December, 2016. All randomized controlled trials (RCTs) comparing IF and EF for unstable intertrochanteric fractures were assessed and selected by two researchers independently. Data were analyzed using Review Manager 5.1 version.

RESULTS

17 RCTs were enrolled in our meta-analysis comparing IF and EF and showed evidence that IF had lower rate of implant failure RR = 0.2695%CI 0.13-0.51, P < 0.0001 and re-operation (RR = 0.60, 95%CI 0.37-0.98, P = 0.04), while there was no statistical differences of cut-out, postoperative infections and other complications. Moreover, PPM scores verified that IF had better postoperative hip mobility recovery (MD = 0.87, 95%CI 0.08-1.66, P = 0.03).

CONCLUSION

IF has lower incidence of failure of implant and reoperation and shows better postoperative functional recovery when treating adult unstable intertrochanteric fracture while the most postoperative complications were not statistically different from EF.

LEVEL OF EVIDENCE: Level I, therapeutic study.