Comparisons of internal fixation treatments for femoral intertrochanteric fractures: a network meta-analysis

Objective: To identify the optimal treatment of femoral intertrochanteric fracture through multiple comparisons of gamma nail (GN), sliding hip screw (SHS), proximal femoral nail (PFN), proximal femoral nail antirotation (PFNA), percutaneous compression plate (PCCP), and Targon proximal femoral (Targon PF). Methods: We searched the Embase and PubMed databases in accordance with inclusion and exclusion criteria. Quality assessment was performed using the recommendation of the Cochrane Collaboration. All outcomes were assessed using odds ratio, standardized mean difference, and 95% confidence interval. The random-effects model was used to examine all the outcomes. Node-splitting analysis and the Brooks-Gelman-Rubin method were applied for consistency test and convergence assessment, respectively. The Aggregate Data Drug Information System was used for the statistical analysis. Results: In total, 31 eligible studies were included. The multiple comparisons indicated that PFNA for blood loss and non-union, PCCP for operative time and mortality, SHS for embolism, intraoperative fracture and later fracture, and Targon PF for reoperation and wound infection were the optimal treatments. Rank probability showed that SHS was the best option for blood loss, embolism, intraoperative fracture, and later fracture; and Targon PF, for operative time, mortality, non-union, reoperation, and wound infection. The subgroup analysis revealed that blood loss, cut-out incidence, and wound infection were lowest and the operative time was shortest with the PFN. Conclusion: No optimal internal fixation treatment was identified for femoral intertrochanteric fracture, but PFN may be a better treatment option for unstable femoral intertrochanteric fractures.