Proximal Femoral Nail versus Dynamic Hip Screw in Unstable Intertrochanteric Fractures (Systemic Review and Meta-Analysis)

Abstract

ntertrochanteric femoral fractures are common in the elderly. They account for more than 50% of all hip fractures and are a common orthopedic problem in this age group (1). They are extra capsular fractures of the proximal femur between the greater and lesser trochanters. Due to the mortality and significant morbidity associated with these fractures, they constitute a major challenge to all orthopedic surgeons (2, 3). There are many classification systems for these fractures. The most classic one is Evans' classification which divides them into stable and unstable fractures based on the fracture pattern (4). Management of stable trochanteric femoral fractures by dynamic hip screw (DHS) is proven to be the best option. Studies show that 40% of trochanteric femoral fractures are unstable which have higher failure rate with conventional treatment options than stable ones. The inherent instability of these fractures is due to many factors which are lateral femoral wall insufficiency, fracture of the posteromedial calcar and extension to sub-trochanteric area (3).