Intertrochanteric Fractures in the Elderly Treated with Different Intramedullary Devices: A Systematic Review and Meta-Analysis Based on Comparison Studies.

IF 2.4 Q2 SURGERY

JBJS Reviews Pub Date : 2025-03-25 eCollection Date: 2025-03-01 DOI:10.2106/JBJS.RVW.24.00203

Noah David Miller, Thomas Cho, Laya Gokula, Jiayong Liu

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引用次数: 0

Abstract

Background: Intertrochanteric fractures in the elderly present significant management challenges, with intramedullary (IM) nails increasingly used for fixation. However, the optimal implant type remains debated. Third-generation IM nails, including proximal femoral nail antirotation (PFNA), Gamma 3 (G3), and Intertan (IT), feature helical blades, single lag screws, and dual integrated lag screws, respectively. This meta-analysis evaluates functional outcomes, healing status, and complication rates of intertrochanteric fractures treated with these devices.

Methods: A systematic review and meta-analysis were conducted using PubMed, Embase, CENTRAL, and Google Scholar until November 2024. Randomized controlled trials (RCTs) and observational comparative studies involving patients older than 65 years were included. Outcomes assessed functional scores, healing status, and complications.

Results: Twenty-four studies (6 RCTs, 5 prospective cohort studies, and 13 retrospective cohort studies) involving 2,999 patients were analyzed. The G3, IT, and PFNA groups included 617, 1,124, and 1,258 patients, respectively. Results showed similar functional recovery across devices. Perioperative parameters favored PFNA, while IT demonstrated lower complication and revision rates. No outcomes favored G3, suggesting it is interchangeable with other devices. PFNA was easier to use and required shorter operation times but had higher cutout and revision rates. IT, despite longer operation times, promoted faster fracture healing and had fewer complications. G3 did not outperform other devices in any measured outcome.

Conclusion: PFNA, G3, and IT provide comparable functional outcomes and overall complication rates, making device selection largely dependent on surgeon preference. However, IT may be the superior choice for complex fractures requiring more excellent stability due to its lower complication and revision rates. This analysis highlights the importance of tailoring implant selection to individual patient needs and fracture complexity.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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不同髓内装置治疗老年股骨粗隆间骨折：基于比较研究的系统回顾和荟萃分析。

背景：老年人粗隆间骨折的治疗面临着重大挑战，髓内钉（IM）越来越多地用于固定。然而，最佳种植体类型仍有争议。第三代IM钉，包括股骨近端防旋钉（PFNA）， Gamma 3 （G3）和Intertan (IT)，分别具有螺旋刀片，单螺钉和双集成螺钉。本荟萃分析评估了使用这些装置治疗转子间骨折的功能结局、愈合状况和并发症发生率。方法：到2024年11月，使用PubMed、Embase、CENTRAL和谷歌Scholar进行系统评价和荟萃分析。随机对照试验（rct）和观察性比较研究纳入了年龄大于65岁的患者。结果评估了功能评分、愈合状况和并发症。结果：共分析了24项研究（6项随机对照试验、5项前瞻性队列研究和13项回顾性队列研究），涉及2999例患者。G3、IT和PFNA组分别包括617例、1124例和1258例患者。结果显示不同设备的功能恢复相似。围手术期参数倾向于PFNA，而IT表现出较低的并发症和翻修率。没有结果支持G3，这表明它可以与其他设备互换。PFNA更容易使用，所需的手术时间更短，但切割和翻修率更高。尽管手术时间较长，但IT促进骨折愈合更快，并发症更少。G3在任何测量结果中都没有优于其他设备。结论：PFNA、G3和IT提供了相当的功能结果和总体并发症发生率，使得器械的选择在很大程度上取决于外科医生的偏好。然而，对于需要更好稳定性的复杂骨折，IT可能是更好的选择，因为它的并发症和翻修率较低。这一分析强调了根据患者个体需求和骨折复杂性定制植入物选择的重要性。证据等级：治疗性III级。有关证据水平的完整描述，请参见作者说明。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JBJS Reviews SURGERY-

CiteScore

4.40

自引率

4.30%

发文量

132

期刊介绍： JBJS Reviews is an innovative review journal from the publishers of The Journal of Bone & Joint Surgery. This continuously published online journal provides comprehensive, objective, and authoritative review articles written by recognized experts in the field. Edited by Thomas A. Einhorn, MD, and a distinguished Editorial Board, each issue of JBJS Reviews, updates the orthopaedic community on important topics in a concise, time-saving manner, providing expert insights into orthopaedic research and clinical experience. Comprehensive reviews, special features, and integrated CME provide orthopaedic surgeons with valuable perspectives on surgical practice and the latest advances in the field within twelve subspecialty areas: Basic Science, Education & Training, Elbow, Ethics, Foot & Ankle, Hand & Wrist, Hip, Infection, Knee, Oncology, Pediatrics, Pain Management, Rehabilitation, Shoulder, Spine, Sports Medicine, Trauma.