Key result
Intramedullary nails provided modest improvements in functional outcomes like the Parker mobility score (MD 0.70) compared to dynamic hip screws, with no differences in quality of life or mortality.
Why the study?
Post-operative rehabilitation outcomes between intramedullary nails and dynamic hip screws in patients with intertrochanteric hip fractures required comparison.
Do intramedullary nails improve post-operative functional, quality of life, and survival outcomes compared to dynamic hip screws in adults with intertrochanteric hip fractures?
Systematic Review
Do intramedullary nails improve post-operative functional, quality of life, and survival outcomes compared to dynamic hip screws in adults with intertrochanteric hip fractures?
Mean Difference: 0.7 (95% CI 0.12–1.28)
p-value: p=0.03
In adults with intertrochanteric hip fractures, intramedullary nails provide modest improvements in specific functional mobility scores compared to dynamic hip screws, but do not significantly affect overall quality of life or mortality.
Modest mobility and hip score gains favor intramedullary nails; extends functional evidence without affecting quality of life or mortality.
Objective We conducted a systematic review and meta-analysis to compare post-operative rehabilitation outcomes between two common treatments in patients who have suffered an intertrochanteric hip fracture: intramedullary nails vs dynamic hip screws. Methods We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science up to August 10, 2022. The inclusion criteria were defined as Population: adults (>18 years old); Interventions/Comparators: intramedullary nails and dynamic hip screws; Outcomes: function, quality of life and survival; and Study type: randomized controlled trials and non-randomized studies. A meta-analysis was performed, and the fixed-effect model was selected to pool the data for homogeneous studies (I 2 < 50%) and the random effect model was selected for heterogeneity I 2 >50%. The P -value of less than 0.05 was considered statistically significant. A narrative synthesis was conducted on the remaining outcomes with insufficient data (ie, missing means, or standard deviations). Results 108 studies were included in the review. 42 studies had outcomes that were included in the meta-analysis. There were modest differences after sensitivity analysis for the Parker mobility score mean difference (MD) = 0.70, 95% CI [0.12, 1.28], T = 3.11, df = 5, P = 0.03, and Harris hip score (MD = 0.94, 95% CI [0.34, 1.54], T = 3.54, df = 9, P = 0.006) favoring the nails. There were no statistically significant differences in the Functional Independence Measure (FIM) (MD = −2.50, 95% CI [−6.46, 1.45], Z = 1.24, P = 0.22), the Barthel Index (MD = 2.66, 95% CI [−7.60, 12.92], T = 1,12, df = 2, P = 0.38), the generic quality of life (MD = 0.04, 95% CI [−0.08, 0.17], Z = 0.70, P = 0.49), the health-related quality of life (MD = −0.14, 95% CI [−3.57, 3.28], Z = 0.08, P = 0.93) or mortality (1.00, 95% CI [0.96, 1.03], Z = 0.16, P = 0.87) outcomes. Conclusion This review showed some differences in functional outcomes in the treatment of intertrochanteric fractures favoring intramedullary nails over dynamic hip screws. There were no differences between the groups for quality of life and mortality outcomes. The narrative synthesis showed additional outcomes that warrant further investigations.
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Backman et al. (2025) conducted a systematic review in Intertrochanteric hip fractures. Intramedullary nails vs. Dynamic hip screws was evaluated on Parker mobility score (MD 0.70, 95% CI 0.12, 1.28, p=0.03). Intramedullary nails provided modest improvements in functional outcomes like the Parker mobility score (MD 0.70) compared to dynamic hip screws, with no differences in quality of life or mortality.
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