Outcomes of Proximal Femoral Nailing (PFN) in unstable trochanteric fractures; A Meta-Analysis

Abstract

unstable ITF owing to its biomechanical advantages; it effectively supports the posteromedial wall and resists excessive collapse. However, some concerns were raised regarding the implant failure rate following PFN owing to exerted imbalance on implant around hip joint. The results after the study showed that operative characteristics, postoperative complications, and mortality were comparable between PFN and DHS. The current literature showed inconsistent results regarding the efficacy of PFN, as compared to other fixation modalities or hemiarthroplasty. This updated meta-analysis showed that PFN was as effective as the DHS regarding operative characteristics, postoperative complications, and mortality. On the other hand, PFN was superior to Gamma nail in terms of postoperative complications. Concerning PFN versus hemiarthroplasty, the pooled estimates favored PFN in surgery duration, intraoperative blood loss, hospitalization days, HSS, and mortality. Despite that ITFs can be effectively managed by internal fixation with conventional techniques, the peculiar characteristics of a subtype of the affected patients, such as osteoporosis and severely unstable fractures, led to the development of the extra and intramedullary fixation techniques. Although many orthopedic centers favor DHS, it is limited by its high cost and significant blood loss. Recently, PFN has gained momentum in the setting of