Yousif Mohamed Ahmed Mohamed, Salih Monzir, Abdulgadir Mohanad, Abbas Ayman E, Lutfi Turjuman Duha
Department of Orthopaedic Surgery, Burjeel Medical City, Abu Dhabi 92510, United Arab Emirates.
Department of General Surgery, Burjeel Medical City, Abu Dhabi 92510, United Arab Emirates.
World J Orthop. 2024 Aug 18;15(8):796-806. doi: 10.5312/wjo.v15.i8.796.
Among the most frequent hip fractures are trochanteric fractures, which usually occur from low-energy trauma like minor falls, especially in older people with osteoporotic bones.
To evaluate the treatment efficacy of dynamic condylar screws (DCS) and proximal femoral nails (PFN) for unstable intertrochanteric fractures.
To find pertinent randomized controlled trials and retrospective observational studies comparing PFN with DCS for the management of unstable femoral intertrochanteric fractures, a thorough search was carried out. For research studies published between January 1996 and April 2024, PubMed, EMBASE, Scopus, Web of Science, Cochrane Library, and Google Scholar were all searched. The complete texts of the papers were retrieved, vetted, and independently examined by two investigators. Disputes were settled by consensus, and any disagreements that persisted were arbitrated by a third author.
This study included six articles, comprising a total of 173 patients. Compared to the DCS, the PFN had a shorter operation time [mean difference (MD): -41.7 min, 95% confidence interval (95%CI): -63.04 to -20.35, = 0.0001], higher success rates with closed reduction techniques [risk ratio (RR): 34.05, 95%CI: 11.12-104.31, < 0.00001], and required less intraoperative blood transfusion (MD: -1.4 units, 95%CI: -1.80 to -1.00, < 0.00001). Additionally, the PFN showed shorter fracture union time (MD: -6.92 wk, 95%CI: -10.27 to -3.57, < 0.0001) and a lower incidence of reoperation (RR: 0.37, 95%CI: 0.17-0.82, = 0.01). However, there was no discernible variation regarding hospital stay, implant-related complications, and infections.
Compared to DCS, PFN offers shorter operative times, reduces the blood transfusions requirements, achieves higher closed reduction success, enables faster fracture healing, and lowers reoperation incidence.
转子间骨折是最常见的髋部骨折之一，通常由低能量创伤引起，如轻微跌倒，尤其在骨质疏松的老年人中。
评估动力髁螺钉（DCS）和股骨近端髓内钉（PFN）治疗不稳定型转子间骨折的疗效。
通过全面检索，查找比较PFN与DCS治疗不稳定型股骨转子间骨折的相关随机对照试验和回顾性观察性研究。检索了1996年1月至2024年4月发表的研究，检索数据库包括PubMed、EMBASE、Scopus、Web of Science、Cochrane图书馆和谷歌学术。获取论文全文，由两名研究者进行审核和独立审查。争议通过协商解决，持续存在的分歧由第三位作者仲裁。
本研究纳入6篇文章，共173例患者。与DCS相比，PFN的手术时间更短[平均差（MD）：-41.7分钟，95%置信区间（95%CI）：-63.04至-20.35，P = 0.0001]，闭合复位技术成功率更高[风险比（RR）：34.05，95%CI：11.12 - 104.31，P < 0.00001]，术中输血需求更少（MD：-1.4单位，95%CI：-1.80至-1.00，P < 0.00001）。此外，PFN的骨折愈合时间更短（MD：-6.92周，95%CI：-10.27至-3.57，P < 0.0001），再次手术发生率更低（RR：0.37，95%CI：0.17 - 0.82，P = 0.01）。然而，在住院时间、植入物相关并发症和感染方面没有明显差异。
与DCS相比，PFN手术时间更短，减少输血需求，闭合复位成功率更高，骨折愈合更快，再次手术发生率更低。
