Date of publication: 2017-09-04 10:28
All eight studies provided data of operation time, but the data of five studies were eligible in the form of mean and standard deviation (SD). There were 6655 fractures included, 597 patients with the PFN fixation and 558 with the DHS fixation (Table 8 ). The heterogeneity test indicated a statistical evidence of heterogeneity ( , , x75 ). We pooled data by a random effect model which indicated that there was no statistical difference in operation time between the two groups. (mean difference: x7767 , 95 x75 CI: x7767 x7568 , ) (Figure 7 ).
a) Previous surgery of the proximal femur.
b) Pathologic fractures other than osteoporosis.
c)Ongoing chemotherapy or irradiation treatment due to malignancy.
e)Individuals who were unable to give consent.
In our series we found that PFN was superior to DHS in many ways such as reduced intra-operative blood loss, lesser operative time, reduced radiation exposure, less amount of shortening, reduced hospital stay, lesser infection rates and early mobilization.
We have concluded that all reverse oblique fractures are to be managed by PFN only as the chances of failure of fixation are very high with extra-medullary devices.
In summary, PFN and DHS are equally effective in the treatment of trochanteric fractures. With future modifications to these two types of implants, more high-quality randomized controlled trials and further studies are needed to investigate whether these changes can lead to different outcomes.
The analysis of operation time showed no significant difference between the two groups. But there was a notable heterogeneity, which could probably be explained by the different levels of experience of surgeons, and the duration of PFN fixation could be shortened as surgical skills improved.
Targon PFN fixation was also included [ 75 , 78 ], which offered a biaxial fixation of the proximal fragment [ 79 ], and was inserted in a similar method into the intramedullary cavity [ 65 ]. It was considered as a type of PFN implant.
6 Department of Orthopaedics, West China Hospital, Sichuan University, No. 87 Guoxue Xiang, Chengdu, Sichuan 665596, China
7 Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
Nailing has the advantage of providing rotational as well as axial stability in cases of sub-trochanteric fractures allowing a faster postoperative restoration of walking ability, when compared with the DHS. The nails are load-sharing implants, whereas extra-medullary devices are load-bearing. Proximal femoral nailing creates a shorter lever arm, which translates to a lower bending moment and a decreased rate of mechanical failure 57.