Publication: Bipolar hemiarthroplasty versus proximal femoral nailing in elderly patients with unstable intertrochanteric fractures: A systematic review and meta-analysis
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Date
2022
Authors
Rahuman, Parveez Rahman Rabik
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Abstract
Introduction and Objectives Unstable intertrochanteric femoral fractures in the elderly is either treated by fixation or joint replacement surgery. Bipolar hemiarthroplasty (BHA) and proximal femoral nail (PFN) are the two most common interventions in current practice and PFN is generally considered to be most ideal. However, hemiarthroplasty is advocated to facilitate early mobilization in recent practice. Currently there is no consensus on the superiority between these two interventions and this review was performed to resolve that uncertainty. Our aim is to answer the question of whether PFN is a better alternative to BHA for unstable intertrochanteric femur fractures in the elderly. Hence the main objective of conducting the present systematic review and meta-analysis was to determine the superiority of PFN over BHA by comparing the postoperative outcomes like mortality rate and harris hip scores (HHS). Additionally, secondary outcomes like injury to surgery time, rate of revision surgery, intra-operative blood loss, period of immobilization, and period of hospitalization were compared. Methodology Four electronic databases of PubMed, Scopus, Web of Science, and the Cochrane Library were searched for relevant articles that directly compared BHA and PFN in unstable intertrochanteric femur fractures in the elderly. Results We analyzed a total of 13 studies published between the years 2012 to 2022. There were 11 retrospective cohort and two randomized controlled studies. The number of patients in these studies ranged from 44 to 308. There was a significant difference in HHS between two groups with standard mean difference (MD) of − 7.60 (range − 10.83 to −4.36), favouring the PFN group. The BHA group had a greater mortality rate with odds ratio (OR) of 1.47 (range 1.14 to 1.90). Moreover intraoperative blood loss (MD: 206.86) and period of immobilization (MD: 0.35) were lower in the PFN group. There were no difference in the rate of revision surgery (OR- 0.76), period of hospitalisation and injury to surgery time (MD: -1.35). Conclusion Treatment of unstable intertrochanteric femoral fractures in the elderly with proximal femoral nailing is superior to bipolar hemiarthroplasty as PFN had overall lower mortality rate and higher functional results. This is attributed to the PFN procedure being quicker and reduced intraoperative blood loss. Proximal femoral nail is superior to bipolar hemiarthroplasty for unstable intertrochanteric femoral fractures in the elderly. PFN imparts better functional outcomes and has lower rates of overall mortality. Additionally, it is faster surgery, with lesser blood loss contributing to better results.
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Keywords
Proximal femoral nail , Bipolar hemiarthroplasty