Comparative Study between Dynamic Hip Screw (DHS) with Lateral Stabilizing Plate versus Proximal Femoral Nail (PFN) in Fixation of Unstable Intertrochanteric Fractures. A Systematic Review & Meta-Analysis

Abstract Background Intertrochanteric fractures are one of the elementary orthopaedic clinical problems accounting for 7% of osteoporotic fracture. These kind of fractures usually caused by low-energy trauma such as a fall from standing height with several risk factors including; increasing age, female gender, osteoporosis, a history of falls, and gait abnormalities. Usually intertrochanteric fracture is classified according to its stability. Fracture stability is dependent on the status of the posteromedial cortex. Stable fractures are commonly simple fractures which are less affected by vertical stress during one-leg standing. Unstable intertrochanteric fracture has decreased ability to resist stress due to affection of Posteromedial or Lateral femoral cortex. Patients and Methods Asystematic review & Meta analysis was design with a careful consideration of the Cochrane Handbook for Systematic Reviews of Interventions. We also will follow The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines during the design of our study. Population: Patients with unstable Intertrochanteric fractures, intervention: Dynamic hip screws (DHS) with lateral stabilizing plate(TSP), comparator: Proximal Femur Nail, outcome parameters: Functional and radiological, study design: Clinical trials whether randomized or nonrandomized prospective or retrospective cohort, case control studies. Results Use of TSP with DHS can give good results in unstable inter trochanteric fractures. As compared to DHS with TSP, PFN is technically more demanding surgery and in our meta analysis and systematic review study we found complication rate of PFN to be higher as compared to DHS with TSP. Addition of TSP to DHS gives good lateral wall buttress which prevent excessive medialization of shaft and gives comparable result to PFN which is considered as better implant in unstable fractures. Conclusion The current systematic review indicated that there is no statistically significant difference between patients operated with Dynamic Hip Screw with Trochanteric lateral Stabilization Plate and Proximal Femoral Nail.