J Korean Med Sci.  2017 May;32(5):858-867. 10.3346/jkms.2017.32.5.858.

Early Rehabilitation in Elderly after Arthroplasty versus Internal Fixation for Unstable Intertrochanteric Fractures of Femur: Systematic Review and Meta-Analysis

• Yoo JI
• Ha YC
• Lim JY
• Kang H
• Yoon BH
• Kim H

• KMID: 2375089
• DOI: http://doi.org/10.3346/jkms.2017.32.5.858

Abstract

The purpose of this study was to compare the outcomes focusing on the functional outcome and clinical results of replacement arthroplasty (AP) vs. internal fixation (IF) for the treatment of unstable intertrochanteric femoral fracture in elderly. Systematic review and meta-analysis were performed on 10 available clinical studies (2 randomized controlled trials and 8 comparative studies). Subgroup analysis was performed by type of methodological quality. Partial weight bearing time in AP group was earlier than that in IF group (SMD = −0.86; 95% CI = −0.42, 1.29; P = 0.050). The overall outcomes such as mortality, reoperation rate, and complication showed no significant diffrence between the 2 groups (AP vs. IF). Therefore, this systematic review demonstrates that AP provides superior functional outcomes especially earlier mobilization, as compared to IF in elderly patients with an unstable intertrochanteric femoral fracture.

Keyword

Arthroplasty; Fracture Fixation; Meta-analysis; Hip Fractures

MeSH Terms

Aged*
Arthroplasty*
Arthroplasty, Replacement
Femoral Fractures
Femur*
Fracture Fixation
Hip Fractures*
Humans
Mortality
Rehabilitation*
Reoperation
Weight-Bearing

Figure

• 

  Fig. 1 PRISMA flow diagram details the process of relevant clinical study selection. PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

• 

  Fig. 2 The forest plot of the outcomes comparing AP with IF. (A) Mortality. (B) Reoperation. (C) Complication-related medical condition. (D) Complication-related operation. AP = arthroplasty, IF = internal fixation, OR = odds ratio; CI = confidence interval, M-H = Mantal-Haenszel.

• 

  Fig. 3 The forest plot of the outcomes comparing AP with IF. (A) Functional outcome. (B) Mobilization time. AP = arthroplasty, IF = internal fixation, SMD = standardized mean difference, SD = standard deviation, CI = confidence interval, MH = Mantal-Haenszel.

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