AI Article Synopsis
- The study aims to compare the effectiveness of intramedullary and extramedullary fixation methods for treating unstable femoral intertrochanteric fractures, as the optimal surgical method is debated.
- A review of 11 randomized controlled trials involving 1,543 patients showed that intramedullary fixation resulted in significantly better functional scores and less blood loss compared to extramedullary fixation, with no major differences in other outcomes.
- The conclusion recommends intramedullary fixation due to its better results in functional scores and blood loss; however, the authors call for more large-scale trials to explore various internal fixation methods further.
Article Abstract
Purpose: Intramedullary and extramedullary fixation methods are widely used to treat unstable femoral intertrochanteric fractures, but the optimal surgical method remains controversial. The aim of this study was to estimate the outcomes of intramedullary fixation versus extramedullary fixation in treating unstable femoral intertrochanteric fractures.
Methods: Electronic literature databases were used for searching including MEDLINE (Ovid interface), EMBASE (Ovid interface) and the Cochrane Central Register of Controlled Trials (CENTRAL) (Wiley Online Library) (up to March 30, 2016). Only human studies, which were designed as randomized controlled clinical trials, were included. Two authors independently evaluated the quality of original literature and extracted data from eligible literature.
Results: Eleven randomized controlled trials involving 1,543 patients were included. Intramedullary fixation was significantly better in functional scores (SMD 0.43, 95 % CI 0.14-0.73, P = 0.004) and had less blood loss (SMD -0.96, 95 % CI -1.77 to -0.11, P = 0.03) in contrast with extramedullary fixation. No obvious discrepancies were found in adverse events, operative time, blood transfusion, and hospital stay between intramedullary and extramedullary fixations.
Conclusion: Our meta-analysis of 11 prospective randomized controlled trials suggested: no obvious discrepancies were found in adverse events, operative time, blood transfusion, and hospital stay between intramedullary and extramedullary fixations. Given the better results of intramedullary fixation in terms of functional scores and blood loss, we recommend the intramedullary fixation technique in treating unstable femoral intertrochanteric fractures. Large multi-center RCTs, which focused on unstable femoral intertrochanteric fractures, are needed to evaluate the efficiency of alternative internal fixation strategies in the future.
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| http://dx.doi.org/10.1007/s00264-016-3308-y | DOI Listing |
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