Intramedullary Nailing versus Sliding Hip Screw Fixation for Intertrochanteric Femoral Fractures: A Systematic Review and Meta-Analysis of Clinical and Radiological Outcomes

Sachin N C; Tejal V V; Vedavathi H

doi:10.51168/krkdnn16

Autori

Sachin N C Senior Registrar, Apollo Hospital, Bannerghatta Road, Bangalore -560076, Karnataka, India
Tejal V V Resident, Indira Maternity and Skin Laser Center, Station Road, Tumkur- 572102, Karnataka, India
Vedavathi H Professor and Head, Department of Pharmacology, Shimoga Institute of Medical Sciences, Shimoga 577201, Karnataka, India

DOI:

https://doi.org/10.51168/krkdnn16

Cuvinte cheie:

cephalomedullary nail, dynamic hip screw, intertrochanteric fracture, intramedullary nail, meta-analysis, pertrochanteric fracture, sliding hip screw

Rezumat

Background: Intertrochanteric femoral fractures are commonly fixed with a cephalomedullary intramedullary nail (IMN) or a sliding hip screw (SHS). Implant use has shifted toward IMN despite persistent uncertainty regarding patient-important benefit, particularly for stable fracture patterns.

Objective: To update randomized evidence comparing IMN and SHS fixation and to synthesize clinical, functional, and radiological outcomes reported in high-quality reviews published through 2025.

Methods: A focused systematic update used the 21-randomized-trial corpus reported by Shin and colleagues as the anchor evidence set. Targeted PubMed/MEDLINE, Cochrane, trial-registry, with eligible publications restricted to 31 December 2025. A subsequent multicentre randomized trial was added. Revision or surgical failure was pooled as an odds ratio (OR) using inverse-variance methods. Secondary outcomes were synthesized from the contemporary trial and high-quality systematic reviews. Risk of bias, heterogeneity, small-study effects, and certainty were considered outcome specifically.

Results: Twenty-two randomized trials contributed 4,431 participants to the revision/surgical-failure analysis. Events occurred in 100 of 2,204 SHS-treated and 93 of 2,227 IMN-treated participants. The pooled estimate did not demonstrate a clear difference (OR 1.14, 95% CI 0.84-1.54; I²=0%; P=0.401). The 2023 INSITE trial found no clinically meaningful 1-year EQ-5D difference (mean difference 0.02, 95% CI -0.03 to 0.07), no significant revision difference, and no interaction by fracture stability. Broader evidence showed little difference in mortality, return to theatre, or quality of life; older nail designs were associated with more implant-related femoral fractures. Small pooled differences in mobility scores favouring IMN were of uncertain clinical importance.

Conclusion: For stable or reducible AO/OTA 31-A1 and selected 31-A2 fractures, SHS remains an evidence-supported, lower-cost option, while IMN does not provide a consistent patient-important advantage. For unstable A2, reverse-obliquity, or subtrochanteric-extension patterns, fracture mechanics and current guidelines favour cephalomedullary fixation, although direct comparative certainty for several outcomes remains limited.

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