Intertrochanteric Fractures in the Elderly Treated with Different Intramedullary Devices: A Systematic Review and Meta-Analysis Based on Comparison Studies.

BACKGROUND

Intertrochanteric fractures in the elderly present significant management challenges, with intramedullary (IM) nails increasingly used for fixation. However, the optimal implant type remains debated. Third-generation IM nails, including proximal femoral nail antirotation (PFNA), Gamma 3 (G3), and Intertan (IT), feature helical blades, single lag screws, and dual integrated lag screws, respectively. This meta-analysis evaluates functional outcomes, healing status, and complication rates of intertrochanteric fractures treated with these devices.

METHODS

A systematic review and meta-analysis were conducted using PubMed, Embase, CENTRAL, and Google Scholar until November 2024. Randomized controlled trials (RCTs) and observational comparative studies involving patients older than 65 years were included. Outcomes assessed functional scores, healing status, and complications.

RESULTS

Twenty-four studies (6 RCTs, 5 prospective cohort studies, and 13 retrospective cohort studies) involving 2,999 patients were analyzed. The G3, IT, and PFNA groups included 617, 1,124, and 1,258 patients, respectively. Results showed similar functional recovery across devices. Perioperative parameters favored PFNA, while IT demonstrated lower complication and revision rates. No outcomes favored G3, suggesting it is interchangeable with other devices. PFNA was easier to use and required shorter operation times but had higher cutout and revision rates. IT, despite longer operation times, promoted faster fracture healing and had fewer complications. G3 did not outperform other devices in any measured outcome.

CONCLUSION

PFNA, G3, and IT provide comparable functional outcomes and overall complication rates, making device selection largely dependent on surgeon preference. However, IT may be the superior choice for complex fractures requiring more excellent stability due to its lower complication and revision rates. This analysis highlights the importance of tailoring implant selection to individual patient needs and fracture complexity.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.