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Journal of Orthopaedic Surgery and Research
Published in: Journal of Orthopaedic Surgery and Research 1/2018

Open Access 01-12-2018 | Review

Comparing surgical interventions for intertrochanteric hip fracture by blood loss and operation time: a network meta-analysis

Authors: Zhengan Hao, Xifeng Wang, Xingqun Zhang

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2018

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Abstract

Background

Multiple operative treatments are available for the fixation of intertrochanteric femoral fractures. This analysis was conducted to provide guidance on the appropriate clinical choice to accommodate individual patients.

Methods

A systematic review was performed to identify relevant articles in databases. Randomized controlled trials (RCTs) of adults with intertrochanteric femoral fractures were eligible if they compared 2 or more of the following interventions: proximal femoral nail anti-rotation (PFNA), percutaneous compression plate (PCCP) use, dynamic hip screw (DHS) fixation, gamma nail (GN) fixation, and artificial femoral head replacement (FHR). Bayesian network meta-analysis was performed to simultaneously compare all treatment methods.

Results

In total, 24 active-comparator studies involving 3097 participants were identified. Across all populations, greater reductions in blood loss and operation time were observed for PFNA than for other treatments. In terms of bleeding, more blood loss was observed for DHS use than for the PFNA (SMD, 1.96; 95% CI, 1.01–1.96), PCCP (SMD, 1.26; 95% CI, 0.31–2.20), and GN (SMD, 0.26; 95% CI, − 0.35–0.87) techniques. However, a more beneficial effect was observed for DHS use than for FHR (SMD, − 0.23; 95% CI, − 1.26–0.81). DHS use resulted in a significantly longer duration of operation time than the PFNA (SMD, 0.75; 95% CI, − 0.02–0.75), PCCP (SMD, 0.61; 95% CI, − 0.20–1.44), and GN (SMD, 0.25; 95% CI, − 0.26–0.77) techniques. Similarly, greater reductions in operation time were observed for DHS use than for FHR (SMD, − 0.12; 95% CI, − 1.15–0.91).

Conclusions

The findings provide supporting evidence demonstrating the superiority of PFNA over other treatments for intertrochanteric femoral fracture. PFNA treatment results in the lowest amount of blood loss and the shortest operation time. These findings add to the existing knowledge of intertrochanteric femoral fracture treatment options.
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Metadata
Title
Comparing surgical interventions for intertrochanteric hip fracture by blood loss and operation time: a network meta-analysis
Authors
Zhengan Hao
Xifeng Wang
Xingqun Zhang
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Journal of Orthopaedic Surgery and Research / Issue 1/2018
Electronic ISSN: 1749-799X
DOI
https://doi.org/10.1186/s13018-018-0852-8

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