External fixation versus dynamic hip screw in treatment of elderly intertrochanteric hip fractures: A systematic review and meta-analysis.

Objective: To evaluate the effect of external fixation compared with dynamic hip screw (DHS) for the treatment of elderly intertrochanteric hip fractures.

Methods: We searched Pubmed, Embase, Cochrane central database (All to December 19th, 2015) for comparative studies relevant to external fixation versus DHS for the management of intertrochanteric hip fractures. Only randomized controlled trial (RCT) were included. We extracted the trial characteristics, intervention details, primary and secondary outcomes. Risk of bias was assessed. Fixed/random effect model was adapted according to the heterogeneity tested by I2 statistic. Sensitivity analysis was conducted and publication bias was assessed.

Results: A total of 4 RCTs were retrieved involving 260 patients. Pooled results showed for the primary outcomes of Harris hip score and final mortality, no significant difference was found between external fixation and DHS, however, for the secondary outcomes, external fixation had advantages in the aspects of length of surgery, operative blood loss, blood transfusion and hospital stay while shortcomings in pin-track infection. For other secondary outcomes such as fracture reduction, cut out and varus malunion, no significant difference could be found.

Conclusions: While there was no conclusive evidence, as external fixation with less surgery time, less blood loss and less post-operative pain while no compromise in final functional outcome and mortality compared with DHS, it could be considered as an alternative for the elderly intertrochanteric hip fractures, especially in highrisk patients who could not tolerate routine spinal anesthesia and open surgery.