Intertrochanteric Fractures in the Elderly Treated with Different Intramedullary Devices: A Systematic Review and...

Area of Science:

• Orthopedic surgery
• Traumatology
• Biomaterials engineering

Background:

• Intertrochanteric fractures are a significant challenge in the elderly population.
• Intramedullary (IM) nails are commonly used for fixation, but optimal implant choice is debated.
• Third-generation IM nails include proximal femoral nail antirotation (PFNA), Gamma 3 (G3), and Intertan (IT).

Purpose of the Study:

• To compare functional outcomes, healing status, and complication rates of PFNA, G3, and IT nails for intertrochanteric fractures in the elderly.
• To evaluate the efficacy and safety of different third-generation IM nail designs.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials and observational comparative studies.
• Inclusion of studies published until November 2024, focusing on patients over 65 years old.
• Assessment of functional scores, healing status, and complication rates.

Main Results:

• Similar functional recovery was observed across PFNA, G3, and IT nail groups.
• PFNA showed favorable perioperative parameters and ease of use but higher cutout and revision rates.
• IT demonstrated lower complication and revision rates, with faster fracture healing, while G3 showed no significant advantages over other devices.

Conclusions:

• PFNA, G3, and IT nails provide comparable functional outcomes and overall complication rates.
• Device selection may depend on surgeon preference, but IT may be superior for complex fractures due to enhanced stability.
• Tailoring implant selection to individual patient needs and fracture complexity is crucial.