Meta-Analysis
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Aug 18, 2024; 15(8): 796-806
Published online Aug 18, 2024. doi: 10.5312/wjo.v15.i8.796
Comparative efficacy of proximal femoral nail vs dynamic condylar screw in treating unstable intertrochanteric fractures
Ahmed Mohamed Yousif Mohamed, Monzir Salih, Mohanad Abdulgadir, Ayman E Abbas, Duha Lutfi Turjuman
Ahmed Mohamed Yousif Mohamed, Mohanad Abdulgadir, Department of Orthopaedic Surgery, Burjeel Medical City, Abu Dhabi 92510, United Arab Emirates
Monzir Salih, Ayman E Abbas, Department of General Surgery, Burjeel Medical City, Abu Dhabi 92510, United Arab Emirates
Duha Lutfi Turjuman, Medical Intern, Burjeel Medical City, Abu Dhabi 92510, United Arab Emirates
Co-first authors: Ahmed Mohamed Yousif Mohamed and Monzir Salih.
Author contributions: Yousif Mohamed AM, Salih M, Abdulgadir M, Abbas AE, and Turjuman DL designed the research study, extracted and analyzed the data, and prepared the report; All authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ahmed Mohamed Yousif Mohamed, MBBS, Doctor, Department of Orthopaedic, Burjeel Medical City, 28th Street, Mohamed Bin Zayed, Abu Dhabi 92510, United Arab Emirates. ahmedtom11@hotmail.com
Received: May 22, 2024
Revised: June 23, 2024
Accepted: July 19, 2024
Published online: August 18, 2024
Processing time: 82 Days and 16.1 Hours
Abstract
BACKGROUND

Among the most frequent hip fractures are trochanteric fractures, which usually occur from low-energy trauma like minor falls, especially in older people with osteoporotic bones.

AIM

To evaluate the treatment efficacy of dynamic condylar screws (DCS) and proximal femoral nails (PFN) for unstable intertrochanteric fractures.

METHODS

To find pertinent randomized controlled trials and retrospective observational studies comparing PFN with DCS for the management of unstable femoral intertrochanteric fractures, a thorough search was carried out. For research studies published between January 1996 and April 2024, PubMed, EMBASE, Scopus, Web of Science, Cochrane Library, and Google Scholar were all searched. The complete texts of the papers were retrieved, vetted, and independently examined by two investigators. Disputes were settled by consensus, and any disagreements that persisted were arbitrated by a third author.

RESULTS

This study included six articles, comprising a total of 173 patients. Compared to the DCS, the PFN had a shorter operation time [mean difference (MD): -41.7 min, 95% confidence interval (95%CI): -63.04 to -20.35, P = 0.0001], higher success rates with closed reduction techniques [risk ratio (RR): 34.05, 95%CI: 11.12-104.31, P < 0.00001], and required less intraoperative blood transfusion (MD: -1.4 units, 95%CI: -1.80 to -1.00, P < 0.00001). Additionally, the PFN showed shorter fracture union time (MD: -6.92 wk, 95%CI: -10.27 to -3.57, P < 0.0001) and a lower incidence of reoperation (RR: 0.37, 95%CI: 0.17-0.82, P = 0.01). However, there was no discernible variation regarding hospital stay, implant-related complications, and infections.

CONCLUSION

Compared to DCS, PFN offers shorter operative times, reduces the blood transfusions requirements, achieves higher closed reduction success, enables faster fracture healing, and lowers reoperation incidence.

Keywords: Intertrochanteric fracture, Unstable, Dynamic condylar screw, Proximal femoral nail, Meta-analysis, Comparative study

Core Tip: The management of unstable intertrochanteric fractures frequently utilizes both proximal femoral nails and dynamic condylar screws. This meta-analysis critically examined the effectiveness thereof, aiming to identify the superior treatment option. These findings are pivotal to refine surgical strategies, ultimately aiming to improve patient outcomes in managing these challenging orthopedic injuries.