title: Intramedullary and extramedullary fixations for the treatment of unstable femoral intertrochanteric fractures: a meta-analysis of prospective randomized controlled trials.
abstract: Intramedullary and extramedullary fixation methods are widely used to treat unstable femoral intertrochanteric fractures, but the optimal surgical method remains controversial. The aim of this study was to estimate the outcomes of intramedullary fixation versus extramedullary fixation in treating unstable femoral intertrochanteric fractures.
  
  
  
  Electronic literature databases were used for searching including MEDLINE (Ovid interface), EMBASE (Ovid interface) and the Cochrane Central Register of Controlled Trials (CENTRAL) (Wiley Online Library) (up to March 30, 2016). Only human studies, which were designed as randomized controlled clinical trials, were included. Two authors independently evaluated the quality of original literature and extracted data from eligible literature.
  
  
  
  Eleven randomized controlled trials involving 1,543 patients were included. Intramedullary fixation was significantly better in functional scores (SMD 0.43, 95 % CI 0.14-0.73, P = 0.004) and had less blood loss (SMD -0.96, 95 % CI -1.77 to -0.11, P = 0.03) in contrast with extramedullary fixation. No obvious discrepancies were found in adverse events, operative time, blood transfusion, and hospital stay between intramedullary and extramedullary fixations.
  
  
  
  Our meta-analysis of 11 prospective randomized controlled trials suggested: no obvious discrepancies were found in adverse events, operative time, blood transfusion, and hospital stay between intramedullary and extramedullary fixations. Given the better results of intramedullary fixation in terms of functional scores and blood loss, we recommend the intramedullary fixation technique in treating unstable femoral intertrochanteric fractures. Large multi-center RCTs, which focused on unstable femoral intertrochanteric fractures, are needed to evaluate the efficiency of alternative internal fixation strategies in the future.
authors.affiliation: Department of Orthopaedics, The Second Affiliated Hospital of Wenzhou Medical University, 109# Xue Yuan Xi Road, Wenzhou, Zhejiang, 325000, China.
authors.forename: A-Bing
authors.initials: AB
authors.lastname: Li
authors.affiliation: Department of Orthopaedics, The Second Affiliated Hospital of Wenzhou Medical University, 109# Xue Yuan Xi Road, Wenzhou, Zhejiang, 325000, China.
authors.forename: Wei-Jiang
authors.initials: WJ
authors.lastname: Zhang
authors.affiliation: Department of Cardiology, The Second Affiliated Hospital of Wenzhou Medical University, 109# Xue Yuan Xi Road, Wenzhou, Zhejiang, 325000, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Orthopaedics, The Second Affiliated Hospital of Wenzhou Medical University, 109# Xue Yuan Xi Road, Wenzhou, Zhejiang, 325000, China.
authors.forename: Wei-Jun
authors.initials: WJ
authors.lastname: Guo
authors.affiliation: Department of Orthopaedics, The Second Affiliated Hospital of Wenzhou Medical University, 109# Xue Yuan Xi Road, Wenzhou, Zhejiang, 325000, China.
authors.forename: Xin-Hua
authors.initials: XH
authors.lastname: Wang
authors.affiliation: Department of Orthopaedics, The Second Affiliated Hospital of Wenzhou Medical University, 109# Xue Yuan Xi Road, Wenzhou, Zhejiang, 325000, China. wmuorthopaedic@sina.com.
authors.forename: You-Ming
authors.initials: YM
authors.lastname: Zhao
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails / Q000009:adverse effects; D016208:Databases, Factual; D005592:Fracture Fixation / Q000009:adverse effects / Q000379:methods*; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D016896:Treatment Outcome
keywords: Extramedullary fixation; Intramedullary fixation; Meta-analysis; Randomized controlled trials; Unstable femoral intertrochanteric fractures