Comparison of clinical outcomes with proximal femoral nail anti-rotation versus InterTAN nail for intertrochanteric femoral fractures: A meta-analysis

Objective: To access the efficacy and safety of proximal femoral nail anti-rotation (PFNA) and InterTAN nail for intertrochanteric femoral fractures.Methods: According to the Cochrane systemic analysis method, randomized control trials (RCTs) and retrospective comparative observational studies which were related to the comparison of PFNA and InterTAN nail in the treatment of the elderly with intertrochanteric fractures were retrieved. Data were independently extracted from the included studies by two reviewers and analyzed using RevMan 5.3 , and the quality of the studies was assessed.Results: Two RCTs and seven observational studies were recruited, which consisted of 681 patients with PFNA and 651 patients with InterTAN nail. The meta-analyses showed no significant differences between the two approaches on Harris Hip Score, operation time, blood loss, time to union, mean hospital stay, union problems, intraoperative complications, hematoma, infection, other complication in both RCTs and observational studies. In terms of other outcomes, for the RCTs, results showed that there were shorter tip–apex distance, reduced pain at thigh or hip in InterTAN nail than in PFNA; however, InterTAN nail was not superior to PFNA in cutout, reoperation, and femoral shaft fracture; for observational studies, the risk of the screw migration (RR=5.13, 95%CI: [1.33,19.75], P=0.02), cutout (RR=3.26, 95%CI: [1.64,6.47], P=0.0008), the varus collapse of the femoral head (RR=7.19, 95%CI: [2.18,23.76], P=0.001), femoral shaft fracture (RR=5.73, 95%CI: [2.24,14.65], P=0.0003) treated by InterTAN nail were significantly decreased, compared with those by PFNA; however, no significant differences was observed in the aspects of tip–apex distance and pain at thigh or hip between these two groups.Conclusion: Analysis of a large number of relevant clinical indicators available shows that InterTAN nail has better clinical manifestation than PFNA in treating unstable femoral intertrochanteric fractures.