The role of lateral wall reconstruction in improving surgical outcomes for intertrochanteric femur fractures

Abstract

Purpose

Intertrochanteric fractures are the most common type of proximal femur fractures, with lateral wall fractures occurring in approximately 33% of cases. This meta-analysis compared the effectiveness of intramedullary fixation methods, specifically the proximal femoral nail (PFN) and the proximal femoral nail anti-rotation (PFNA), to other treatment options.

Methods

A systematic review was conducted using PubMed, Scopus, Web of Science and Embase, following PRISMA guidelines. We included clinical trials on intertrochanteric femur fractures with lateral wall involvement. Random effects models were used to analyze mean differences across treatment methods, with statistical evaluations including I², Cochran's Q, sensitivity analyses, and Egger's test. Additionally, a subgroup analysis was performed.

Results

Of the initial 1009 results, 10 studies involving 516 patients were included. The surgical methods assessed included PFN/PFNA, PFN with trochanteric buttress plates, screw-augmented PFN, PFNA with a sliding compression plate and InterTan. Blood loss was significantly greater in the experimental models (MD: 31.83, 95% confidence interval [CI]: 0.28–63.38, p < 0.001, I² = 99%). Union time was reduced in the experimental models (MD: −0.60, 95% CI: −0.95 to −0.24, p = 0.18, I² = 42%). The Harris hip score (HHS) was also higher (MD: 7.03, 95% CI: 4.81–9.26, p = 0.74, I² = 0%).

Conclusion

Combining PFN with lateral wall reconstruction techniques may increase blood loss, decrease union times, and improve functional outcomes, suggesting advantages over PFN or PFNA alone.

Trial Registration

The PROSPERO registration number: CRD42024602939.

Level of Evidence

Level II, systematic review of Level II studies.