[Proximal femoral nail antirotation versus dynamic hip screw for intertrochanteric fracture in elders: a meta-analysis].
OBJECTIVE
To assess the efficacies of proximal femoral nail antirotation (PFNA) versus dynamic hip screw (DHS) for intertrochanteric fracture in elders.


METHODS
The databases of PubMed, Embase, CENTRAL, CBM, CNKI and WANFANG were searched for the relevant randomized controlled trials (RCTs) up to May 18, 2013. After quality evaluation and data extraction by two authors independently, meta-analyses were performed with the RevMan5.1 software. And the levels of evidence were evaluated by the GRADEprofile 3.6 software.


RESULTS
A total of 17 studies (n = 1 344) were included and there were 656 patients in PFNA group and 688 in DHS respectively. Meta-analyses showed that, as compared with DHS, PFNA could significantly decrease fixation failure rate (odds ratio (OR) = 0.26, 95% confidence interval (CI) = [0.12, 0.57], P = 0.0008), reduce average fracture healing time (weighted mean difference (WMD) = -15.11, 95%CI = [-24.36, -5.85], P = 0.001), improve excellent and good rate for Harris score (OR = 0.29, 95%CI = [0.15, 0.56], P = 0.0002), yield a higher Harris score (WMD = 6.88, 95%CI = [0.96, 12.80], P = 0.02) and reduce the rate of coxa vara (OR = 0.40, 95%CI = [0.18,0.92], P = 0.03). However, there was no statistical significance in 1-year mortality, postoperative nonunion and delayed union, postoperative femoral head necrosis, postoperative femoral fractures or femoral head necrosis. The importance of outcomes was "critical". And the level of evidences based on the GRADE approach was from "very low" to "low".


CONCLUSIONS
PFNA is superior to DHS. Due to the limitations of the included studies, more large-sample and high-quality RCTs are required. And subgroup analysis based on fracture types should be performed.
Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
Xiaoming
X
Yuan
Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China. Email: yqjh2010@163.com.
Qi
Q
Yao
Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
Jie
J
Ni
Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
Libin
L
Peng
Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
Daxin
D
Yu
D001858:Bone Nails; D001863:Bone Screws; D005264:Femoral Fractures / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation*; D006801:Humans; D016896:Treatment Outcome