Evidence map›Paper›PMID 40119946›Full record

SynthesisArchives of orthopaedic and trauma surgery2025

The fragility of statistical findings in the intertrochanteric fracture fixation literature: a systematic review of randomized controlled trials.

Anya Wang, Avanish Yendluri, Michael N Megafu, John K Cordero, David A Forsh, Scott P Ryan, Paul Tornetta, Robert L Parisien, Investigation performed by the Scientific Collaborative for Orthopaedic Research and Education (SCORE) Group

Abstract readSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Archives of orthopaedic and trauma surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Anya WangIcahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, 10029, USA. anya.wang@icahn.mssm.edu.ORCID http://orcid.org/0009-0001-9133-027X
Avanish YendluriIcahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, 10029, USA.
Michael N MegafuA.T. Still University, 800 W Jefferson St, Kirksville, MO, USA.
John K CorderoIcahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, 10029, USA.
David A ForshIcahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, 10029, USA.
Scott P RyanTufts University School of Medicine, Boston, MA, USA.
Paul TornettaChobanian and Avedisian School of Medicine, 72 E Concord St, Boston, MA, USA.
Robert L ParisienIcahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, 10029, USA.
Investigation performed by the Scientific Collaborative for Orthopaedic Research and Education (SCORE) Group

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionIntertrochanteric fractures are common and can lead to significant disability and morality, particularly in the elderly. Utilizing the fragility index (FI), reverse fragility index (rFI), and fragility quotient (FQ), this study evaluates the statistical fragility of outcomes reported in intertrochanteric fracture fixation randomized controlled trials (RCTs). MATERIALS AND

methodsData sources: Pubmed, Embase, and MEDLINE were queried for RCTs published between 2010-present. STUDY SELECTION: RCTs reporting 1:1 categorical, dichotomous outcomes were included. Articles were excluded if they were not RCTs, had over two treatment groups, included in vitro/animal/cadaveric data, and did not feature intertrochanteric fractures. DATA EXTRACTION: Publication and individual outcome data were collected by three independent reviewers. DATA SYNTHESIS: FI and rFI were calculated as the number of event reversals required to reverse the statistical significance for each outcome. The FQ was calculated by dividing FI by the study sample size. Subgroup analysis was performed based on outcome types.

resultsTwo hundred thirty-two articles were screened, and 52 articles with a total of 370 outcomes were included for analysis. The median FI was 5 (IQR 4-6) with a FQ of 0.05 (IQR 0.032-0.078). 57/370 outcomes were statistically significant with a median FI of 3 (IQR 1-8). 313 outcomes were statistically nonsignificant with a median rFI of 5 (IQR 4-6). The number of patients lost to follow-up was greater than or equal to the FI in 127/370 outcomes (34.32%). Outcomes relating to malunion/nonunion were the most fragile, encompassing 11 outcomes with a median FI of 3 (IQR 2.5-5).

conclusionOutcomes in intertrochanteric fracture fixation RCTs are fragile as reversal of a few outcomes or maintaining follow-up may alter the significance of study findings. Thus, P-values are recommended to be routinely reported with FI and FQ metrics in order to provide a comprehensive understanding of the statistical robustness of outcomes in orthopedic trauma literature. LEVEL OF EVIDENCE: I.

Indexed as

Fracture Fixation, InternalHip FracturesHumansRandomized Controlled Trials as TopicFragility analysisFragility indexIntertrochanteric fracturesRandomized controlled trials

Identifiers

PMID40119946

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.