title: Intramedullary versus extramedullary fixation in the management of subtrochanteric femur fractures: a meta-analysis.
abstract: BACKGROUND
  Intramedullary and extramedullary fixation methods are used in the management of subtrochanteric femur fractures. However, whether intramedullary or extramedullary fixation is the primary treatment for subtrochanteric femur fractures in adults remains debatable.
  
  
  METHODS
  Meta-analyses of prospective studies, level I.
  
  
  METHODS
  The Cochrane library, Embase, Google Scholar, and PubMed databases were searched separately for all relevant studies published before January 1, 2015. No language restriction was applied. Prospective randomized controlled trials that compared intramedullary or extramedullary internal fixation to repair subtrochanteric femur fractures in adults were included. We determined intraoperative data, postoperative complications, fracture fixation complications, wound infection, hospital stay days, and final outcome measures to assess the relative effects of different internal fixation methods for the treatment of subtrochanteric femur fractures in adults.
  
  
  RESULTS
  Six studies were included in our meta-analysis. The relative risks (RRs) of revision rate was 83% lower (RR, 0.17, 95% confidence interval [CI], 0.05 to 0.60; P=0.006), fixation failure rate was 64% lower (RR, 0.36, 95% CI, 0.12 to 1.08; P=0.07), non-union rate was 77% lower (RR, 0.23, 95% CI, 0.07 to 0.81; P=0.02) in the intramedullary group compared with the extramedullary group. No significant differences were found between the intramedullary group and extramedullary group for intraoperative data, postoperative complications, wound infection, hospital stay days or final outcome measures.
  
  
  CONCLUSIONS
  In conclusion, our meta-analysis suggests that there was no significant difference in intraoperative data, postoperative complications, wound infection, hospital stay days or final outcome measures between intramedullary and extramedullary internal fixation. However, a significant decrease occurred in the rate of fracture fixation complications for patients treated with intramedullary internal fixation, especially in elderly patients. Some differences were not significant, but the treatment of elderly subtrochanteric femur fractures using intramedullary internal fixation is recommended.
authors.affiliation: Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, People's Republic of China ; First Clinical Medical College, Nanjing Medical University, Nanjing, People's Republic of China.
authors.forename: Pengcheng
authors.initials: P
authors.lastname: Liu
authors.affiliation: Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, People's Republic of China.
authors.forename: Xing
authors.initials: X
authors.lastname: Wu
authors.affiliation: Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, People's Republic of China ; First Clinical Medical College, Nanjing Medical University, Nanjing, People's Republic of China.
authors.forename: Hui
authors.initials: H
authors.lastname: Shi
authors.affiliation: Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, People's Republic of China.
authors.forename: Run
authors.initials: R
authors.lastname: Liu
authors.affiliation: Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, People's Republic of China.
authors.forename: Hexi
authors.initials: H
authors.lastname: Shu
authors.affiliation: Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, People's Republic of China.
authors.forename: JinPeng
authors.initials: J
authors.lastname: Gong
authors.affiliation: Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, People's Republic of China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, People's Republic of China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Sun
authors.affiliation: Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, People's Republic of China ; First Clinical Medical College, Nanjing Medical University, Nanjing, People's Republic of China.
authors.forename: Jiezhou
authors.initials: J
authors.lastname: Wu
authors.affiliation: Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, People's Republic of China.
authors.forename: Xiaoyang
authors.initials: X
authors.lastname: Nie
authors.affiliation: Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Shanghai, People's Republic of China.
authors.forename: Ming
authors.initials: M
authors.lastname: Cai
mesh_terms: D005269:Femur; D005593:Fracture Fixation, Internal / Q000379:methods*; D005594:Fracture Fixation, Intramedullary / Q000379:methods; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D007902:Length of Stay; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012086:Reoperation; D016896:Treatment Outcome
keywords: extramedullary; intramedullary; meta-analysis; subtrochanteric femur fracture; systematic review