Key result
Proximal femoral nail antirotation (PFNA) showed no significant difference in complication rates compared to gamma nail (RR 0.92), but had the highest probability of being the optimal treatment based on SUCRA scores (77.6%).
Why the study?
Does PFNA, GN, or SHS provide better outcomes and lower complication rates in patients with unstable femoral intertrochanteric fractures?
Meta-Analysis (n=993)
Does PFNA, GN, or SHS provide better outcomes and lower complication rates in patients with unstable femoral intertrochanteric fractures?
Relative Risk: 0.92 (95% CI 0.53–1.6)
p-value: p=0.780
In a network meta-analysis of unstable femoral intertrochanteric fractures, PFNA ranked as the optimal surgical method compared to gamma nails and sliding hip screws, despite similar complication rates.
PFNA may be prioritized for unstable intertrochanteric fractures; extends network ranking evidence among PFNA, GN, and SHS.
// He-Hui Wang 1 , Wu-Bin Shu 1 , Guan-Hua Lan 1 , Xiao-Bo Zhang 1 , Zhi-Qiang Jiang 1 , De-Hong Xu 1 , Xue-Xun Bao 1 and A-Bing Li 1 1 Department of Orthopedics, Ningbo Yinzhou Second Hospital, Ningbo, Zhejiang, 315100, China Correspondence to: A-Bing Li, email: bing19890807@hotmail.com Keywords: unstable femoral intertrochanteric fractures; proximal femoral nail antirotation; gamma nail; sliding hip screws; network meta-analysis Received: October 12, 2017 Accepted: December 05, 2017 Epub: January 02, 2018 Published: May 08, 2018 ABSTRACT In this network meta-analysis, we determined the optimal surgical method for treating unstable femoral intertrochanteric fractures. We searched the EMBASE, Cochrane Library and Medline databases for studies evaluating sliding hip screws (SHS), gamma nail (GN) or proximal femoral nail antirotation (PFNA) methods, and included nine randomized controlled trials that met the inclusion criteria. Our analysis showed no differences in the rates of complications between SHS and PFNA relative to GN ( p > 0.05). However, the surface under the cumulative ranking curve (SUCRA) score for PFNA (77.6%) was higher than the SUCRA scores for GN (65%) and SHS (7.5%). This suggests PFNA is the better surgical method than GN or SHS for unstable femoral intertrochanteric fractures.
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Wang et al. (2018) conducted a meta-analysis in Unstable femoral intertrochanteric fractures (n=993). Proximal femoral nail antirotation (PFNA) vs. Gamma nail (GN) and sliding hip screws (SHS) was evaluated on Complication rates (RR 0.92, 95% CI 0.53-1.60, p=0.780). Proximal femoral nail antirotation (PFNA) showed no significant difference in complication rates compared to gamma nail (RR 0.92), but had the highest probability of being the optimal treatment based on SUCRA scores (77.6%).
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