Replacement Arthroplasty Versus Internal Fixation For Treatment Of Unstable Intertrochanteric Fractures In Elderly Patients: A Systematic Review

ObjectiveTo provide an evidence for the management of unstable intertrochanteric fractures in the elderly, we perform a systematic review on arthroplasty versus internal fixation. MethodsDatabase Medline, P ubmed, EMBASE, CEN TRAL, OVID, Cochrane, CNKI, Wan Fang, CQVIP, Sino Med, C linical Trials, N RR Archive, CCT, Meta-register of Controlled Trials, ISI proceedings, Medical Research Council C linical Trials Directory, CACP, SIGLE were searched by computer for all randomized or quasi- randomized controlled trials on arthroplasty versus internal fixation for unstable intertrochanteric fractures in the elderly. Some relevant orthopaedics journals were also searched manually. Only English or C hinese literatures can be included. Two investigators individually assessed the risk bias of each trial based on the Cochrane Collaboration’s Tool for Assessing Risk of Bias(5.1.0). Each outcome data was subsequently collected and inputted into Revman 5.3.5 for further meta-analysis.ResultsEleven trials were eventually identified, including a total number of 891 patients, among which 406 patients received arthroplasty while 485 patients received internal fixation. In some outcome indicators, internal fixation group should be divided into intramedullary fixation and extramedullary fixation in order to discuss separately. Meta-analysis demonstrates that intramedullary fixation has shorter operation time and less intraoperative bleeding volume, while in the rate of implant-related complications and the rate of reoperation is the same as arthroplasty; extramedullary fixation has more intraoperative bleeding volume, but higher the rate of implant-related complications and the rate of reoperation, while in operation time is the same as arthroplasty; internal fixation has less blood transfusion volume, but longer weight-bearing walking time and hospitalization time, while in the postoperative internal-related complication rate and mortality is the same as arthroplasty; arthroplasty in the early is more efficacy than internal, but the difference between the two groups becomes more and more less obvious along with the time, ultimately no difference. ConclusionThere are insufficient evidences to determine whch has more advantages between arthroplasty and internal fixation for unstable intertrochanteric fractures in the elderly. The surgical method of intertrochanteric fractures in the elderly should be worked out individually. In order to provide a definite evidence for the management of unstable intertrochanteric fractures in the elderly, more randomized controlled trials of larger sample sizes are needed.