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All randomized controlled trials (RCTs) comparing IF and EF for unstable intertrochanteric fractures were assessed and selected by two researchers independently. Data were analyzed using Review Manager 5.1 version.\nResults\n17 RCTs were enrolled in our meta-analysis comparing IF and EF and showed evidence that IF had lower rate of implant failure RR = 0.2695%CI 0.13\u20130.51, P &lt; 0.0001 and re-operation (RR = 0.60, 95%CI 0.37\u20130.98, P = 0.04), while there was no statistical differences of cut-out, postoperative infections and other complications. Moreover, PPM scores verified that IF had better postoperative hip mobility recovery (MD = 0.87, 95%CI 0.08\u20131.66, P = 0.03).\nConclusion\nIF has lower incidence of failure of implant and reoperation and shows better postoperative functional recovery when treating adult unstable intertrochanteric fracture while the most postoperative complications were not statistically different from EF.\nLevel of evidence\nLevel I, therapeutic study.\nER -<\/jats:p>","DOI":"10.1016\/j.aott.2018.02.009","type":"journal-article","created":{"date-parts":[[2018,3,27]],"date-time":"2018-03-27T08:59:45Z","timestamp":1522141185000},"page":"299-307","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":70,"title":["Intramedullary versus extramedullary internal fixation for unstable intertrochanteric fracture, a meta-analysis"],"prefix":"10.5152","volume":"52","author":[{"given":"Xi","family":"YU","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"WANG","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"DUAN","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming","family":"L\u0130U","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhou","family":"X\u0130ANG","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3111","published-online":{"date-parts":[[2020,2,6]]},"reference":[{"issue":"5","key":"10.1016\/j.aott.2018.02.009_bib1","doi-asserted-by":"crossref","first-page":"1450","DOI":"10.1007\/s11999-010-1263-2","article-title":"Fractures in brief: intertrochanteric hip fractures","volume":"468","author":"Ahn","year":"2010","journal-title":"Clin Orthop Relat Res"},{"issue":"4","key":"10.1016\/j.aott.2018.02.009_bib2","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1016\/j.aott.2016.06.008","article-title":"Incidence of second hip fractures and associated mortality in Taiwan: A nationwide population-based study of 95,484 patients during 2006\u20132010","volume":"50","author":"Lee","year":"2016","journal-title":"Acta Orthop Traumatol Turc"},{"issue":"2","key":"10.1016\/j.aott.2018.02.009_bib3","doi-asserted-by":"crossref","first-page":"E63","DOI":"10.25011\/cim.v38i1.22577","article-title":"Quality of life following treatment of trochanteric fractures with proximal femoral nail versus cementless bipolar hemiarthroplasty in elderly","volume":"38","author":"Desteli","year":"2015","journal-title":"Clin Invest Med"},{"issue":"6","key":"10.1016\/j.aott.2018.02.009_bib4","doi-asserted-by":"crossref","first-page":"636","DOI":"10.4103\/0019-5413.193479","article-title":"Results of a compression pin alongwith trochanteric external fixation in management of high risk elderly intertrochanteric fractures","volume":"50","author":"Arslan","year":"2016","journal-title":"Indian J Orthop"},{"issue":"5","key":"10.1016\/j.aott.2018.02.009_bib5","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1302\/0301-620X.93B5.25539","article-title":"Dynamic hip screw versus DHS blade: a biomechanical comparison of the fixation achieved by each implant in bone","volume":"93","author":"O'Neill","year":"2011","journal-title":"J Bone Joint Surg Br"},{"issue":"7","key":"10.1016\/j.aott.2018.02.009_bib6","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1097\/BOT.0000000000000036","article-title":"Short versus long cephalomedullary nails for the treatment of intertrochanteric hip fractures in patients older than 65 years","volume":"28","author":"Kleweno","year":"2014","journal-title":"J Orthop Trauma"},{"issue":"4","key":"10.1016\/j.aott.2018.02.009_bib7","doi-asserted-by":"crossref","first-page":"S10","DOI":"10.1097\/BOT.0000000000000286","article-title":"Nailing intertrochanteric hip fractures: short versus long; 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