Intramedullary nailing versus sliding hip screw for AO/OTA 31-A2 and 31-A3 trochanteric fractures: a systematic review and meta-analysis of randomized controlled trials.

Study Summary

18 randomized controlled trials including 3237 adult patients with AO/OTA 31-A2 and 31-A3 unstable trochanteric femoral fractures were included in this systematic review and meta-analysis comparing intramedullary nailing (IMN) vs sliding hip screw (SHS) fixation. The primary outcomes of interest included mortality and reoperation. The secondary outcomes of interest were the incidence of surgical complications, non union, implant failures and postoperative pain, functional outcomes, mobility, and surgical parameters. Outcomes were measured over 12 months. IMN demonstrated similar short and 12-month mortality to SHS. However, SHS showed a higher tendency towards reoperation rates and while IMN was associated with lower rates of arthroplasty conversion, nonunion, and infection, together with reduced early postoperative pain, improved functional and recovery, shorter operative time, and less intraoperative blood loss. Overall, the findings suggest that IMN may provide superior clinical outcomes for unstable trochanteric fractures, although the certainty of evidence was predominantly low to moderate and implant selection should remain individualized.