The percutaneous compression plate versus the dynamic hip screw for treatment of intertrochanteric hip fractures: A systematic review and meta-analysis of comparative studies - 08/10/12

Doi : 10.1016/j.otsr.2012.07.004

J. Ma ^a,^b,^{^{1
The first two authors contributed equally to this work.}}, D. Xing ^b,^d,^{^{1
The first two authors contributed equally to this work.}}, X. Ma ^b,^c,^⁎ , W. Xu ^c, J. Wang ^b, Y. Chen ^c, D. Song ^d
^a College of Precision Instrument and Opto-electronics Engineering, Tianjin University, 92, Weijin Street, Nankai District, Tianjin 300072, China
^b Department of Orthopaedics, Tianjin Medical University General Hospital, 154, Anshan Street, Heping District, Tianjin 300052, China
^c Department of Orthopaedics Institute, Tianjin Hospital, 406, Jiefang Nan Street, Hexi District, Tianjin 300211, China
^d Department of Orthopaedics, Tianjin Gongan Hospital, 176, Nanjing Street, Heping District, Tianjin 300042, China

Corresponding author. Tel./fax: +86 22 60362062.

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Summary

Background

The use of a percutaneous compression plate (PCCP) provides a minimally invasive technique for the fixation of stable intertrochanteric femoral fractures. It has several theoretically potential advantages over the dynamic hip screw (DHS) such as shorten incision and lower incidence of wound infection.

Hypothesis

PCCP have several advantages than DHS, such as reduced blood loss, transfusion, mortality, shorter operative time, and lower incidence of complications. This systematic review and meta-analysis was performed to identify the clinical outcomes and safety of patients with stable intertrochanteric hip fractures operated on using PCCP compared with DHS.

Materials and methods

A systematic search of all studies published through April 2012 was conducted using the Medline, Embase, Sciencedirect, OVID and the Cochrane Central database. The randomized controlled trials (RCTs) and quasi-randomised control trials (qRCTs) that compared PCCP with DHS in treating adult patients with stable intertrochanteric hip fractures and provided data on safety and clinical effects were identified. Demographic characteristics, adverse events and clinical outcomes were manually extracted from all of the selected studies.

Results

Nine studies encompassing 914 patients met the inclusion criteria. Overall, the result of meta-analysis indicated that over DHS, PCCP allowed significantly shorter operative time, reduced blood loss as well as transfusion, diminished incidence of cardiovascular events. However, there were no significant differences in length of hospitalization, rate of walking without help, early mortality and other complications.

Discussion

Significant differences favoring PCCP were found with regard to operative time, blood loss, transfusion and lower incidence of cardiovascular events. However, owing to the limitations of this systematic review, future RCTs are still needed to confirm this data and the clinical efficiency of PCCP.