23 Evaluating the Efficacy of Cephalomedullary Nail Versus Arthroplasty for Intertrochanteric Fractures in Elderly Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

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Abstract Background The optimal surgical intervention for managing intertrochanteric fractures remains a topic of debate, with cephalomedullary nail fixation and arthroplasty being the two most widely implemented procedures. To address this controversy and provide evidence-based guidance, a comprehensive evaluation of the efficacy of these two treatment modalities is recommended. Aim The purpose of this systematic review and meta-analysis is to compare the efficacy of cephalomedullary nail fixation versus arthroplasty in treating of intertrochanteric femoral fractures in terms of operation time (min), intraoperative bleeding (mL), length of hospital stays (days), harris hip score (HHS), overall mortality, time to weight bearing (days), postoperative complications, and reoperation. Method Relevant studies were searched in the electronic databases PubMed, Web of Science, Cochrane Central and Scopus databases up to June 2023 with English language restriction. for randomized controlled trials which compared the clinical outcomes of intertrochanteric fractures managed with either cephalomedullary nail (CMN) or arthroplasty. Relevant data of the surgical information and postoperative outcomes were pooled and analysed using RevMan 5.4 version. Results FHR operations result in longer surgery time and more blood loss compared to CMN procedures, but they lead to enhanced short-term recovery, including faster weight bearing and improved hip function. FHR procedures are linked to increased incidence of 1-year mortality rates. Conclusions Future research should prioritize rigorous, CT-based studies on unstable intertrochanteric fractures (ITF) using randomized trials with patient-reported outcomes to assess hip function. Emphasis should be on patient-centred assessments and comparing outcomes across fracture types.

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