title: Internal fixation treatments for intertrochanteric fracture: a systematic review and meta-analysis of randomized evidence.
abstract: The relative effects of internal fixation strategies for intertrochanteric fracture after operation remain uncertain. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to address this important issue. We searched PubMed, EMBASE and CENTRAL for RCTs that compared different internal fixation implants in patients with intertrochanteric fracture at 6-month follow-up or longer. We ultimately included 43 trials enrolling 6911 patients; most trials were small in sample sizes and events. Their risk of bias was generally unclear due to insufficient reporting. Because of these, no statistically significant differences were present from most of the comparisons across all the outcomes, and no definitive conclusions can be made. However, a number of trials compared two commonly used internal fixation strategies, gamma nail (GN) and sliding hip screw (SHS). There is good evidence suggesting that, compared to SHS, GN may increase the risk of cut out (OR = 1.87, 95% CI, 1.08 to 3.21), re-operation (OR = 1.61, 95% CI, 1.02 to 2.53), intra-operative (OR = 3.14, 95% CI, 1.34 to 7.35) and later fractures (OR = 3.67, 95% CI, 1.37 to 9.83). Future randomized trials or observational studies that are carefully designed and conducted are warranted to establish the effects of alternative internal fixation strategies for intertrochanteric fracture.
authors.affiliation: Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China, 610041.
authors.forename: Jiajie
authors.initials: J
authors.lastname: Yu
authors.affiliation: Center for Evidence-based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Hubei, China, 442000.
authors.forename: Chao
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China, 610041.|Clinical Research and Evaluation Unit, West China Hospital, Sichuan University,610041.
authors.forename: Ling
authors.initials: L
authors.lastname: Li
authors.affiliation: Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China, 610041.|Clinical Research and Evaluation Unit, West China Hospital, Sichuan University,610041.
authors.forename: Joey S W
authors.initials: JS
authors.lastname: Kwong
authors.affiliation: Department of orthopedics, The third people's hospital of Chengdu, Chengdu, China,610031.
authors.forename: Li
authors.initials: L
authors.lastname: Xue
authors.affiliation: Center for Evidence-based and Translational Medicine, Zhongnan Hospital, Wuhan University, Wuhan, China,430071.
authors.forename: Xiantao
authors.initials: X
authors.lastname: Zeng
authors.affiliation: School of Public Health, Curtin University, Perth, WA, Australia, 6845.
authors.forename: Li
authors.initials: L
authors.lastname: Tang
authors.affiliation: Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China, 610041.|Clinical Research and Evaluation Unit, West China Hospital, Sichuan University,610041.
authors.forename: Youping
authors.initials: Y
authors.lastname: Li
authors.affiliation: Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China, 610041.|Center for Evidence-based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Hubei, China, 442000.|Clinical Research and Evaluation Unit, West China Hospital, Sichuan University,610041.
authors.forename: Xin
authors.initials: X
authors.lastname: Sun
mesh_terms: D016063:Blood Loss, Surgical; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D006620:Hip Fractures / Q000401:mortality / Q000601:surgery*; D006760:Hospitalization; D006801:Humans; D011446:Prospective Studies; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D019233:Retreatment; D016896:Treatment Outcome