Proximal Femoral Nail vs Arthroplasty for Unstable Intertrochanteric Fracture in Elderly (Systematic Review & Meta Analysis)

Abstract Background Hip fractures impose a considerable economic burden on healthcare, with intertrochanteric fractures contributing to increasing morbidity. The global incidence of hip fractures is expected to rise to 4.5 million by 2050, primarily due to aging and osteoporosis. Osteoporosis weakens bones, making them susceptible to fractures even from minor traumas, with femoral intertrochanteric fractures being prone to comminution. Aim of the Work To compare between proximal femoral nail and arthroplasty for Unstable intertrochanteric fracture in elderly. The objective is to perform a systematic review to better management procedure. Patients and Methods This systematic review and meta-analysis aimed to compare arthroplasty and proximal femoral nail (PFN) fixation for unstable intertrochanteric fractures in elderly patients. The study included 24 studies with 2699 patients, analyzing factors such as surgery duration, peri-operative blood loss, blood transfusion, complications, Harris hip score (HHS), and mortality. Results PFN had a significantly shorter surgery duration compared to arthroplasty, with the latter exhibiting higher blood loss. Arthroplasty also required more blood transfusion, attributed to its invasive nature. While complications did not significantly differ between groups, arthroplasty showed a higher rate of thromboembolic complications. Mortality rates were significantly higher in the arthroplasty group, emphasizing the importance of early mobilization for patient outcomes. Conclusion Underscores the significant superiority of PFN over hemiarthroplasty in treating elderly patients with intertrochanteric fractures. The PFN group had a statistically shorter operative time, less blood loss, lower mortality compared to the arthroplasty group. However, no significant differences in functional outcomes using HHS were observed between the two compared groups. In addition, no significant differences were found concerning complications between the PFN and arthroplasty groups.