Comparison of helical blade versus lag screw in intertrochanteric fractures of the elderly treated with proximal femoral nail: A meta-analysis of randomized-controlled trials
1Department of Orthopedic Trauma and Hand Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
2Department of Joint Surgery, the Third Affiliated Hospital of Guangxi Medical University, Nanning, China
Keywords: Elderly, helical blade, intertrochanteric fracture, intramedullary fixation, lag screw, meta-analysis.
Objectives: In this review, we aimed to compare the radiological and functional outcomes between the helical blade and lag screw in treating intertrochanteric fractures among the elderly and to provide suggestions for clinical treatment.
Materials and methods: Between January 1st, 1990 and January 12th, 2022, the literature search in document databases identified eligible randomized-controlled trials (RCT) studies directly comparing the helical blade and lag screws for treating hip fractures. The mechanical failure rates, the excellent and good rate of fracture reduction, Harris Hip Score (HHS), and postoperative hip pain of two intramedullary devices (helical blades versus lag screws) in patients with intertrochanteric fractures were analyzed using the RevMan software and Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The random-effects models were used for statistical analysis.
Results: A total of 11 articles containing 1,146 patients for helical blade and lag screw comparison were included. Compared to the lag screws, the mechanical failure rate (odds ratio [OR]=0.71, 95% confidence interval [CI] 0.40-1.27, p=0.25), the excellent and good rate of fracture reduction (OR=1.33, 95% CI 0.61-2.90, p=0.48), HHS (mean differences 1.83, 95% CI -0.29-1.83, p=0.09), and postoperative hip pain (OR=0.41, 95% CI 0.14-1.21, p=0.11) were similar with the helical blades. There was no significant difference between the two implants in terms of the treatment outcomes.
Conclusion: Both helical blades and lag screws are good choices for treating intertrochanteric fracture among elderly.
Citation: Huang J, Wei Q. Comparison of helical blade versus lag screw in intertrochanteric fractures of the elderly treated with proximal femoral nail: A meta-analysis of randomized-controlled trials. Jt Dis Relat Surg 2022;33(3):695-704.
Designed the study, collected the data, analysed the results, generated figures,and wrote the paper: J.H.; Literature search,article revision: Q.W.
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
The authors received no financial support for the research and/or authorship of this article.
The authors thanks Dr. Peng Huang (Maternal and Child Health Hospital of Guangxi Province) for helping write the paper, and my wife Xiaofei Zhang (Maternal and Child Health Hospital of Guangxi Province) for giving me advises in conceiving this study.