A meta-analysis of integrated compression screw compared to single screw nails using a single lag screw or single helical blade screw for intertrochanteric hip fractures

Background: Surgical treatment is the optimal strategy for managing intertrochanteric fractures as it allows early rehabilitation and functional recovery.We sought to assess the clinical effectiveness of commonly used intramedullary devices for the treatment of unstable intertrochanteric hip fractures and also assess if there was a class effect of these nails.Methods: A comprehensive systematic literature review and meta-analysis of studies was conducted comparing an Integrated Compression Screw nail (ICS) with conventional single screw nails using a single lag screw (SLS) or a single helical blade (SHB).We assessed the following outcomes, device related complications (shaft fracture, varus collapse and cut-outs), revisions, non-unions, hip and thigh pain, Harris Hip Score, health related quality of life, operating and fluoroscopy time, blood loss and other complications.We report odds ratios for dichotomous outcomes and mean difference for continuous outcomes.Results: Twelve studies with 1,661 patients were included, 8 comparing ICS with SHB and 4 comparing ICS with SLS.Mean age was 76 years and 71% of patients were female.There were significant differences (p<0.05) in device performance in favour of ICS for implant related failures, fewer revisions, hip and thigh pain and better function as measured by SF-36 and HHS compared to single screw nails.Operating time and fluoroscopy time significantly favoured single screw nails.No differences were seen in non-unions, blood loss, and other complications.Conclusion: Our meta-analysis suggests that there are significant differences between ICS and the single screw nails in favour of ICS with respect to the incidence of implant related failures, revision, functional outcomes and proportion of patients reporting hip and thigh pain.Operating time favours the single screw nails while no differences were observed regarding non-unions, blood loss and other complications.There is no evidence of class effect regarding intrameduallary nails in this patient population.