A Meta-analysis Comparing Lateral Decubitus with Supine Position for Surgery for Intertrochanteric Fractures

Purpose: There are few studies compares surgery with proximal femoral nail antirotation (PFNA) in lateral decubitus with that in supine position about their advantages and disadvantages for patients with intertrochanteric femoral fractures. Previous studies reported conflicting findings. This meta-analysis was to compare the efficacy and safety of surgery with PFNA in different surgical positions. Methods: Relevant randomized controlled trials comparing surgery with PFNA in lateral decubitus with surgery in supine position for intertrochanteric fractures patients were included into this meta-analysis. Inclusion criteria of this meta-analysis were: randomized controlled trials comparing lateral decubitus with supine position for surgery for intertrochanteric fractures and reporting at least one of the main outcomes, including blood loss, operating time, hospital stay, and length of incision, Harris values and union time. Results: Six randomized controlled trials were finally included into this meta-analysis. Pooled results showed that there were less blood loss, less operation time, smaller incision and higher Harris values score in lateral decubitus group. Sensitivity analysis by sequential omission of individual studies showed the significance of weighted mean difference was robust, which suggested this outcome was credible. Conclusions: Surgery with PFNA in lateral decubitus can benefit intertrochanteric fractures patients with less blood loss, less operation time, shorter incision and high Harris values scores compared with surgery in supine position according to our research.