Intramedullary Nailing versus Dynamic Screw and Plate for Treatment of Trochanteric Fractures of the Femur Systematic Review and Meta-Analysis

Abstract

rochanteric and intertrochanteric femur fractures are extracapsular fractures of the proximal femur at the level of the greater and lesser trochanter. Trochanteric fractures in adults mostly affect elderly subjects. Frequency is increasing with population aging despite the development of treatments for osteoporosis. The two most widely used types of internal fixation are intramedullary nailing and screw-plate fixation, often performed by trainee surgeons due to their frequency and reputed simplicity. Trochanteric fracture involves the proximal femur between the cervical region and the shaft. Subtrochanteric fracture, with a fracture line running from an area within 5 cm distal to the lesser trochanter, is usually also included in the definition. There are numerous classifications of trochanteric fractures, based on fracture line location, displacement, and the consequences for external reduction maneuvers. Trochanteric fractures together with femoral neck fractures, they constitute the category of proximal femoral fractures, for which more than 80,000 cases were reported in France in 2005. In elderly subjects, trochanteric fractures result from bone fragility associated with frequent falls, induced by certain medical drugs such as hypnotics and also recent antihypertensive treatments. It often follows a simple fall, resulting in total lower-limb impotence. The classic deformity pattern of shortening, adduction and external rotation may not apply when there is no displacement. AP and lateral hip X-ray confirms diagnosis and determines classification and CT is indicated only to detect occult fracture