JOURNAL READING

Early Rehabilitation in Elderly after

Arthroplasty versus Internal Fixation
for Unstable Intertrochanteric
Fractures of Femur:
a Systematic Review and Meta-
Analysis
NAME : BIMA SATRIA AJI
dr. Wisnu Murti, Sp.OT
NIM : 30101507407
Author, date
Early Rehabilitation in Elderly after Arthroplasty versus Internal Fixation for
Unstable Intertrochanteric
Fractures of Femur:

• un-Il Yoo, • Hyun Kang

• Yong-Chan Ha • Byung-Ho
• Jae-young Lim, Yoo
• Hyunho Kim

Medical Author 1 Medical Author 2

Department of Department of
Orthopaedic Orthopaedic
Surgery, School of Surgery, Chung-
Medicine, Ang University
Gyeongsang College of
National University Medicine, Seoul,
Hospital, Jinju, Korea
Place Korea Place

Source : 2017 The Korean Academy of Medical Sciences.

 RESEARCH
PURPOSES
To compare

Fungtional result Clinical

result

For the treatment of unstable interthrochanteric

femoral fractures in the elderly
 INTRODUCTION
Hip fracture is considered an important Although surgical options for hip fractures vary,
health problem in the elderly population, the the primary goal is early rehabilitation and return
number of hip fractures is expected to to previous social activities. Fixation of stable
and early hip fractures allows for early
increase in the next decade rehabilitation.

1 2

12
3
34 4

Arthroplasty replacement (AP) or internal several studies report the choice of AP and IF is
fixation (IF) is considered as 2 surgical more suitable for early rehabilitation in patients
options for stable fixation after hip fracture with unstable intertrochanteric fractures, AP vs
IF replacement remains controversial
INCLUSION CRITERIA
research design: randomized controlled trial (RCT) or non-randomized comparison study

Study population: Patients with unstable intertrochanter fractures in the femur

classification: 2 and 3 or Evans classification

interventions: including AP (total hip arthroplasty (THA) or hemiarthroplasty) and IF such

as intramedral nails or sliding hip screws (control group)

follow-up time: at least 1 year

report at least 1 of the following main clinical outcomes: death, repeat surgery for any
cause, condition or medical operation related to complications, functional outcome and
time of mobilization
 Methodological quality assessment
Are inclusion and exclusion criteria
clearly defined?

Are results from patients who withdrew or were excluded

Did not come reported and if so, were less than 5
after the allocation explained and included in the in-to-
percent of participants not coming?
treat analysis?

Are groups suitable, or are appropriate Does the outcome assessor not know the
Contents Title status of the assignment? Are the results timing
covariate adjustments made?
You can simply suitable?
impress your
audience.

Are all outcome measures clearly defined in the text

Does the surgeon have experience of surgery with definitions of each ambiguous term encountered?
performed at the trial, before the start?

Are the treatment programs apart from

the trial option identical?
 Search result

270 references are issued by filtering

out abstracts and titles for duplicates,
unrelated articles, case reports,
systematic reviews, and non-
comparative studies
21 further studies were excluded
1 301 references from the selected
database
2
3 The remaining 31 studies
underwent full text review
4
5 Two randomized controlled studies and 8 comparative
retrospective studies, 7 English articles and 3 Korean
articles including 1,214 patients (614 from the AP
group, 610 from the IF group)

The main characteristics and results of the studies included in the meta-analysis are presented in Table 1.
Table 1. Characteristics of studies and patients included
 RESULT
Early Rehabilitation in Elderly after Arthroplasty versus Internal Fixation for
Unstable Intertrochanteric Fractures of Femur
 Meta Analysis Results

Figure 3. Results of comparing AP with IF. (A) Functional results. (B) Time of mobilization.
 DISCUSSION
Early Rehabilitation in Elderly after Arthroplasty versus Internal
Fixation for Unstable Intertrochanteric Fractures of Femur

To achieve initial rehabilitation and improve short-term

01 outcomes, this meta-analysis study showed better
funtional assessment in the AP and significantly earlier
time to bear a heavy burden in the AP group than in the IF
group

There were no significant differences between the 2

interventions for mechanical complications, local wound
02 complications, reoperation, general complications,
mortality at 1 year or long-term function
 DISCUSSION
Early Rehabilitation in Elderly after Arthroplasty versus Internal
Fixation for Unstable Intertrochanteric Fractures of Femur

the time holding a partial load in the replacement

03 AP group was significantly better than the IF group

Regarding surgical-related complications such as

04 reoperation and mortality in patients after treatment
of unstable intercutaneous fractures, this meta-
analysis shows no statistical difference between AP
and IF treatment for unstable intertrolanteric
fractures in elderly patients
 DISCUSSION
Early Rehabilitation in Elderly after Arthroplasty versus Internal
Fixation for Unstable Intertrochanteric Fractures of Femur

This meta-analysis has several limitations. First,

only 2 RCTs were included. Second, the follow-up
05 period was not long enough to confirm the results
(no study included having more than 5 years of
follow-up). Third, all documents taken are English
or Korean, therefore, there may be language bias

In conclusion, this study shows that AP provides

06 superior functional results especially prior
mobilization when compared with IF in elderly
patients with unstable intertrochanteric femoral
fractures.
 Critical Appraisal
Early Rehabilitation in Elderly after Arthroplasty versus Internal Fixation for
Unstable Intertrochanteric Fractures of Femur
 Judul dan Pengarang

No. Kriteria Ya (+) atau Tidak (-)

1 Jumlah kata dalam judul < 12 kata +

Menggambarkan isi utama

2 Deskripsi judul penelitian, menarik dan tanpa
singkatan

3 Daftar penulis sesuai aturan jurnal +

4 Korespondensi penulis -

5 Tempat & waktu penelitian dalam judul +

 Abstrak

No. Kriteria Ya (+) atau Tidak (-)

1 Abstrak satu paragraf +

2 Secara keseluruhan informatif +

3 Tanpa singkatan selain yang baku +

+
4 Kurang dari 250 kata
136 kata
 Bahan dan Metode Penelitian

No Kriteria Ya (+) atau tidak (-)

1 Jenis dan rancangan penelitian -
2 Waktu dan tempat penelitian +
3 Identifikasi studi -
4 Kriteria inklusi dirinci secara jelas
5 Kriteria ekslusi Tidak dirinci secara jelas
6 Perincian cara penelitian -
7 Uji statistik -
8 Program komputer +
9 Persetujuan subjek -
 Hasil

No. Kriteria Ya (+) atau Tidak (-)

1 Jumlah subjek +

2 Tabel karakteristik subjek -

3 Tabel hasil penelitian +

4 Tabel analisis data +

 Pembahasan, Hasil, dan Daftar Pustaka

No. Kriteria Ya (+) atau Tidak (-)

1 Pembahasan & kesimpulan dipaparkan terpisah -

Pembahasan & kesimpulan dipaparkan dengan

2 +
jelas

3 Pembahasan mengacu dari penelitian sebelumnya +

4 Pembahasan sesuai landasan teori +

5 Keterbatasan penelitian +
6 Simpulan utama +
7 Simpulan berdasarkan hasil penelitian +
8 Saran penelitian -
9 Penulisan daftar pustaka sesuai aturan +
 Thank You
Early Rehabilitation in Elderly after Arthroplasty
versus Internal Fixation for Unstable
Intertrochanteric Fractures of Femur