SynthesisBMC musculoskeletal disorders2026
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.
Synthesis in BMC musculoskeletal disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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.
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.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundTrochanteric femoral fractures (TFFs) are frequent injuries in older adults, with unstable patterns (AO/OTA 31-A2 and A3) carrying a higher risk of complications. Intramedullary nailing (IMN) and sliding hip screw (SHS) are the two main surgical options. However, guideline recommendations differ, and prior meta-analyses are limited. This study aimed to systematically compare the efficacy and safety of IMN versus SHS in treating adult patients with unstable TFFs based on randomized controlled trials (RCTs).
methodsMEDLINE, Embase, and CENTRAL (January 2008-March 2025) were searched for eligible RCTs, which included adults with 31-A2 or A3 fractures randomized to IMN or SHS. Primary outcomes were mortality and reoperation. Secondary outcomes included implant failures, nonunion, surgical parameters, and postoperative mobility, pain, and function. Risk of bias (RoB) was assessed using RoB 2, and the certainty of evidence (CoE) with GRADE.
resultsEighteen RCTs (n = 3237 patients) were included. No significant differences were found between IMN and SHS in three-month (low CoE) and 12-month mortality (moderate CoE). Reoperation rates trended higher with SHS, but not significantly (pooled OR = 1.70; 95% CI, 0.97-2.97; low CoE). SHS was associated with higher rates of arthroplasty conversion (pooled OR 1.92; 95% CI 1.00-3.68; low CoE), nonunion (pooled OR 1.93; 95% CI 1.12-3.34; low CoE), and infection (pooled OR 2.20; 95% CI 1.29-3.74; low CoE), while implant failure did not differ significantly (pooled OR 1.35; 95% CI 0.91 to 2.01; low CoE). IMN was associated with higher functional scores, less pain (within three months), and a greater likelihood of regaining pre-fracture mobility (CoE low- moderate).
conclusionsIMN demonstrated comparable mortality to SHS. Although overall reoperation rates did not differ significantly, IMN was associated with lower odds of arthroplasty conversion, nonunion, and infection, as well as reduced early postoperative pain and improved early postoperative function. However, given the overall low to moderate CoE, these findings should be interpreted with caution. Implant selection should remain individualized, taking into account patient characteristics, fracture morphology, and surgeon experience.
Indexed as
Identifiers
What OpenQuestion holds
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.