Comparison of helical blade versus lag screw in intertrochanteric fractures of the elderly treated with proximal femoral nail: A meta-analysis of randomized-controlled trials

Objectives: In this review, we aimed to compare the radiological and functional outcomes between the helical blade and lag screw in treating intertrochanteric fractures among the elderly and to provide suggestions for clinical treatment. Materials and methods: Between January 1(st), 1990 and January 12(th), 2022, the literature search in document databases identified eligible randomized-controlled trials (RCT) studies directly comparing the helical blade and lag screws for treating hip fractures. The mechanical failure rates, the excellent and good rate of fracture reduction, Harris Hip Score (HHS), and postoperative hip pain of two intramedullary devices (helical blades versus lag screws) in patients with intertrochanteric fractures were analyzed using the RevMan software and Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The random-effects models were used for statistical analysis. Results: A total of 11 articles containing 1,146 patients for helical blade and lag screw comparison were included. Compared to the lag screws, the mechanical failure rate (odds ratio [OR]=0.71, 95% confidence interval [CI] 0.40-1.27, p=0.25), the excellent and good rate of fracture reduction (OR=1.33, 95% CI 0.61-2.90, p=0.48), HHS (mean differences 1.83, 95% CI -0.29-1.83, p=0.09), and postoperative hip pain (OR=0.41, 95% CI 0.14-1.21, p=0.11) were similar with the helical blades. There was no significant difference between the two implants in terms of the treatment outcomes. Conclusion: Both helical blades and lag screws are good choices for treating intertrochanteric fracture among elderly.