Comparing surgical interventions for intertrochanteric hip fracture by blood loss and operation time: a network meta-analysis

Abstract

BackgroundMultiple operative treatments are available for the fixation of intertrochanteric femoral fractures. This analysis was conducted to provide guidance on the appropriate clinical choice to accommodate individual patients.MethodsA systematic review was performed to identify relevant articles in databases. Randomized controlled trials (RCTs) of adults with intertrochanteric femoral fractures were eligible if they compared 2 or more of the following interventions: proximal femoral nail anti-rotation (PFNA), percutaneous compression plate (PCCP) use, dynamic hip screw (DHS) fixation, gamma nail (GN) fixation, and artificial femoral head replacement (FHR). Bayesian network meta-analysis was performed to simultaneously compare all treatment methods.ResultsIn total, 24 active-comparator studies involving 3097 participants were identified. Across all populations, greater reductions in blood loss and operation time were observed for PFNA than for other treatments. In terms of bleeding, more blood loss was observed for DHS use than for the PFNA (SMD, 1.96; 95% CI, 1.01–1.96), PCCP (SMD, 1.26; 95% CI, 0.31–2.20), and GN (SMD, 0.26; 95% CI, − 0.35–0.87) techniques. However, a more beneficial effect was observed for DHS use than for FHR (SMD, − 0.23; 95% CI, − 1.26–0.81). DHS use resulted in a significantly longer duration of operation time than the PFNA (SMD, 0.75; 95% CI, − 0.02–0.75), PCCP (SMD, 0.61; 95% CI, − 0.20–1.44), and GN (SMD, 0.25; 95% CI, − 0.26–0.77) techniques. Similarly, greater reductions in operation time were observed for DHS use than for FHR (SMD, − 0.12; 95% CI, − 1.15–0.91).ConclusionsThe findings provide supporting evidence demonstrating the superiority of PFNA over other treatments for intertrochanteric femoral fracture. PFNA treatment results in the lowest amount of blood loss and the shortest operation time. These findings add to the existing knowledge of intertrochanteric femoral fracture treatment options.

Which implant is superior for treating simple pertrochanteric fractures of the proximal femur in the elderly patients?

“…In accordance with the literature, [23] we found that the mean estimated total blood loss and blood transfusion ratio were significantly lower in the PFNA group than in the DHS and PCCP groups. Contrary to the literature, [6] we found that the mean operation and fluoroscopy times were significantly higher in the PCCP group than in the PFNA and DHS groups.…”

“…Previous studies reported that patients who had 31A1 fractures may have rather different functional outcomes following fixation with various implants. [19][20][21][22][23] The present study demonstrated that the functional outcomes in the groups were similar and satisfactory, according to the HHS. Previous reports have stated that the union time for these fractures with various implants was 12-18 weeks.…”

Optimal surgical methods to treat intertrochanteric fracture: a Bayesian network meta-analysis based on 36 randomized controlled trials

“…Results suggested that PCCP had the lowest probability of operative time than other treatments. However, other studies have drawn the opposite conclusion [19]. Hao et al [19] suggested that PFNA treatment results in shortest operative time than other surgical treatments.…”

“…However, other studies have drawn the opposite conclusion [19]. Hao et al [19] suggested that PFNA treatment results in shortest operative time than other surgical treatments. As surgical experience might influence the operative time, thus more validation studies need to be performed.…”

“…Previous studies have tested different internal fixation techniques for the surgical treatment to provide insight into the option for treating intertrochanteric fractures. However, there is no consensus about the optimal surgical method for intertrochanteric fractures [18,19]. More important, traditional meta-analyses only compare two treatments, while network meta-analysis allows for the simultaneous comparison of multiple interventions through combination of direct and indirect evidences from RCTs.…”