SynthesisArchives of orthopaedic and trauma surgery2024
Extramedullary versus intramedullary fixation of unstable trochanteric femoral fractures (AO type 31-A2): a systematic review and meta-analysis.
Synthesis in Archives of orthopaedic and trauma surgery, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
15 citing papers in PubMed, 3 syntheses or guidelines pooled it, 18 citations in OpenAlex.
- Intramedullary nailing versus sliding hip screw for AO/OTA 31-A2 and 31-A3 trochanteric fractures: a systematic review and meta-analysis of randomized controlled trials.BMC musculoskeletal disorders · 2026Pooled it
- Pooled it
- Short versus long cephalomedullary nails for intertrochanteric femur fractures: A meta-analysis of randomized controlled trials.PloS one · 2025Pooled it
- Article
- Comparison of the Dynamic Cut-Out Failure Modes of Common Proximal Femoral Fixation Devices Using a Mesh-Free Computational Method.Journal of orthopaedic research : official publication of the Orthopaedic Research Society · 2026Article
- Article
- Optimisation strategies for intramedullary nailing parameters in subtrochanteric fractures of the femur: a multimodal assessment based on finite element and biomechanical experiments.International journal of surgery (London, England) · 2025Article
- Article
- The positioning of cephalon medullary nailing correlated with hidden blood loss during the perioperative period in patients with intertrochanteric fractures: A retrospective study.Chinese journal of traumatology = Zhonghua chuang shang za zhi · 2025Article
- Effects and Complications of Hip Arthroplasty After Failure of Internal Fixation in Stable and Unstable Intertrochanteric Femoral Fractures.Orthopaedic surgery · 2025Article
- Controversies in the Treatment Strategies of Intertrochanteric Fractures: A Scoping Review and Discussion of a Literature-Based Algorithm.Journal of clinical medicine · 2025Review
- Short versus long proximal femoral nail anti-rotation-II (PFNA-II) in the management of unstable intertrochanteric fractures.International journal of burns and trauma · 2025Article
- Immediate weight bearing as tolerated versus delayed weight bearing following intramedullary fixation for geriatric intertrochanteric fractures: a post hoc analysis.BMC musculoskeletal disorders · 2024Article
- Comparison of the Surgical Outcome between the Multiple Screw Fixation and Fixed Angle Devices for the Basicervical Femoral Neck Fractures.Medicina (Kaunas, Lithuania) · 2024Article
- Effect of different internal fixation devices on intertrochanteric fractures.American journal of translational research · 2024Article
Corrections and comments
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Authors and funding
9 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveThe aim of this systematic review was to compare extramedullary fixation and intramedullary fixation for AO type 31-A2 trochanteric fractures in the elderly, with regard to functional outcomes, complications, surgical outcomes, and costs.
methodsEmbase, Medline, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar were searched for randomized controlled trials (RCTs) and observational studies. Effect estimates were pooled across studies using random effects models. Results are presented as weighted risk ratio (RR) or weighted mean difference (MD) with corresponding 95% confidence interval (95% CI).
resultsFourteen RCTs (2039 patients) and 13 observational studies (22,123 patients) were included. Statistically superior results in favor of intramedullary fixation were found for Harris Hip Score (MD 4.09, 95% CI 0.91-7.26, p = 0.04), Parker mobility score (MD - 0.67 95% CI - 1.2 to - 0.17, p = 0.009), lower extremity measure (MD - 4.07 95% CI - 7.4 to - 0.8, p = 0.02), time to full weight bearing (MD 1.14 weeks CI 0.92-1.35, p < 0.001), superficial infection (RR 2.06, 95% CI 1.18-3.58, p = 0.01), nonunion (RR 3.67, 95% CI 1.03-13.10, p = 0.05), fixation failure (RR 2.26, 95% CI 1.16-4.44, p = 0.02), leg shortening (MD 2.23 mm, 95% CI 0.81-3.65, p = 0.002), time to radiological bone healing (MD 2.19 months, 95% CI 0.56-3.83, p = 0.009), surgery duration (MD 11.63 min, 95% CI 2.63-20.62, p = 0.01), operative blood loss (MD 134.5 mL, 95% CI 51-218, p = 0.002), and tip-apex distance > 25 mm (RR 1.73, 95% CI 1.10-2.74, p = 0.02). No comparable cost/costs-effectiveness data were available.
conclusionCurrent literature shows that several functional outcomes, complications, and surgical outcomes were statistically in favor of intramedullary fixation when compared with extramedullary fixation of AO/OTA 31-A2 fractures. However, as several of the differences found appear not to be clinically relevant and for many outcomes data remains sparse or heterogeneous, complete superiority of IM fixation for AO type 31-A2 fractures remains to be confirmed in a detailed cost-effectiveness analysis.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.