Intramedullary versus extramedullary internal fixation for unstable intertrochanteric fracture, a meta-analysis

Acta Orthop Traumatol Turc. 2018 Jul;52(4):299-307. doi: 10.1016/j.aott.2018.02.009. Epub 2018 Mar 27.


Objective: The aim of this meta-analysis was to explore the difference between and compare intramedullary fixation (IF) and extramedullary fixation (EF) for unstable intertrochanteric fractures.

Methods: We searched Pubmed database and Cochrane library following by including and excluding articles based from inception to December, 2016. All randomized controlled trials (RCTs) comparing IF and EF for unstable intertrochanteric fractures were assessed and selected by two researchers independently. Data were analyzed using Review Manager 5.1 version.

Results: 17 RCTs were enrolled in our meta-analysis comparing IF and EF and showed evidence that IF had lower rate of implant failure RR = 0.2695%CI 0.13-0.51, P < 0.0001 and re-operation (RR = 0.60, 95%CI 0.37-0.98, P = 0.04), while there was no statistical differences of cut-out, postoperative infections and other complications. Moreover, PPM scores verified that IF had better postoperative hip mobility recovery (MD = 0.87, 95%CI 0.08-1.66, P = 0.03).

Conclusion: IF has lower incidence of failure of implant and reoperation and shows better postoperative functional recovery when treating adult unstable intertrochanteric fracture while the most postoperative complications were not statistically different from EF.

Level of evidence: Level I, therapeutic study.

Keywords: Extramedullary fixation; Internal fixation; Intramedullary fixation; Tip-apex distance; Unstable intertrochanteric fracture.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Bone Nails
  • Fracture Fixation, Internal / methods*
  • Fracture Fixation, Intramedullary / methods
  • Hip Fractures / surgery*
  • Humans