Clinical effects and safety of proximal femur bionic nail versus proximal femoral nail anti-rotation and InterTAN for the treatment of intertrochanteric femoral fracture: a systematic review and meta-analysis

Objective To compare the clinical effects and safety of the proximal femur bionic nail (PFBN) with those of proximal femoral nail anti-rotation (PFNA) and InterTAN for the treatment of intertrochanteric femoral fracture (IFF). Methods Studies comparing the clinical efficacy of PFBN with that of PFNA and InterTAN in the treatment of IFF published before August 2024 in the PubMed, Embase, Web of Science, Cochrane, CNKI, Wanfang, and VIP databases were retrieved. After the research data were extracted, Review Manager 5.4 (RevMan 5.4) was used for data analysis. Results A total of 13 studies involving 825 patients were included. The meta-analysis results indicated that the PFBN group had advantages over the control group in terms of the postoperative partial and full weight-bearing time, fracture healing time, fracture reduction quality, hospital stay, visual analog scale (VAS) score, and postoperative complication rate (partial weight-bearing time: standardized mean difference ( SMD ) = -3.06, 95% confidence interval ( CI ) -4.02~-2.09, P  < 0.00001; full weight-bearing time: SMD = -1.78, 95% CI -2.86~-0.70, P  = 0.001; fracture healing time: SMD = -0.55, 95% CI -0.82~-0.28, P  < 0.0001; fracture reduction quality: relative risk ( RR ) = 1.07, 95% CI 1.01 ~ 1.13, P  = 0.02; hospital stay: SMD = -0.16, 95% CI -0.33 ~ 0.00, P  = 0.05; postoperative VAS score: SMD = -0.54, 95% CI -0.90~-0.18, P  = 0.003; postoperative complication rate: RR  = 0.36, 95% CI 0.21 ~ 0.61, P  = 0.0001). There was no significant difference between the two groups in terms of intraoperative blood loss, operation duration, postoperative hip range of motion, postoperative Harris score, intraoperative fluoroscopy time, or incision length (intraoperative blood loss: SMD = -0.57, 95% CI -1.16 ~ 0.02, P  = 0.06; operation duration: SMD  = 0.28, 95% CI -0.20 ~ 0.76, P  = 0.26; postoperative flexion and extension motion: SMD  = 0.28, 95% CI -0.18 ~ 0.73, P  = 0.23; postoperative rotational motion: SMD  = 0.20, 95% CI -0.25 ~ 0.66, P  = 0.38; postoperative Harris score: SMD  = 0.32, 95% CI 0.00 ~ 0.64, P  = 0.05; intraoperative fluoroscopy time: SMD  = 0.84, 95% CI -0.24 ~ 1.92, P  = 0.13; incision length: SMD = 0.23, 95% CI -0.44 ~ 0.89, P  = 0.50). Conclusion For the treatment of IFF, the PFBN is more effective and has a lower risk than the PFNA and InterTAN.