{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T00:18:08Z","timestamp":1763511488651,"version":"3.45.0"},"reference-count":36,"publisher":"Georg Thieme Verlag KG","issue":"04","license":[{"start":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T00:00:00Z","timestamp":1763424000000},"content-version":"vor","delay-in-days":109,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev Bras Ortop (Sao Paulo)"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>To compare the clinical, functional, and safety outcomes of intramedullary nails with cephalic screws (cephalomedullary nails, CMNs) and the dynamic hip screws (DHSs) in the treatment of unstable intertrochanteric femur fractures (of grades 31-A2\/A3 according to the Arbeitsgemeinschaft f\u00fcr Osteosynthesefragen [AO, Association for the Study of Internal Fixation]\/Orthopaedic Trauma Association [OTA] and III\u2013V according to the Tronzo classification).<\/jats:p>\n                  <jats:p>The present systematic review followed the 2020 guidelines of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, with searches on the PubMed, Scopus, Embase, Cochrane, and Web of Science databases. We included comparative studies (randomized controlled trials or prospective cohorts) published from 2000 to 2025. The outcomes included mortality, implant failure, reoperation, and functional scores. We also conducted an analysis through the random effects model, heterogeneity assessment per I2, and evidence quality per the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.<\/jats:p>\n                  <jats:p>A total of 18 studies were included. The CMN group presented shorter operative time (mean difference [MD]\u2009=\u2009\u221212.3\u2009minutes), lower intraoperative bleeding (MD\u2009=\u2009\u221288\u2009mL), reduced mechanical failure (odds ratio [OR]\u2009=\u20090.42), and fewer reoperations (OR\u2009=\u20090.58). There were no significant differences regarding the functional scores and mortality. The quality of the evidence was high for operative time and mechanical complications, moderate for reoperation, and low for the functional scores.<\/jats:p>\n                  <jats:p>The CMNs were superior to DHS in multiple clinical outcomes for unstable trochanteric fractures, and they should be considered the treatment of choice, especially in cases of greater instability. However, in resource-limited settings, such as those of the Brazilian public hospitals, DHS remains a viable alternative when used with appropriate technical criteria.<\/jats:p>","DOI":"10.1055\/s-0045-1812023","type":"journal-article","created":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T00:16:03Z","timestamp":1763511363000},"page":"001-011","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of Intramedullary Nails with Cephalic Screws and Dynamic Hip Screw in the Treatment of Unstable Intertrochanteric Fractures in Adults \u2013 A Systematic Review and Meta-Analysis"],"prefix":"10.1055","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-3138-2886","authenticated-orcid":false,"given":"Jo\u00e3o","family":"Prot\u00e1sio","sequence":"additional","affiliation":[{"name":"Hospital Geral de Palmas, Universidade Federal do Tocantins, Palmas, TO, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9535-1492","authenticated-orcid":false,"given":"Paulo Victor Dias","family":"Almeida","sequence":"additional","affiliation":[{"name":"Hospital Geral de Palmas, Universidade Federal do Tocantins, Palmas, TO, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2301-8137","authenticated-orcid":false,"given":"Mariana Garcia Martins","family":"Castro","sequence":"additional","affiliation":[{"name":"Palmas Municipal Heath Department, TO, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,11,18]]},"reference":[{"issue":"08","key":"ref1","doi-asserted-by":"publisher","first-page":"1458","DOI":"10.1016\/j.injury.2018.04.015","article-title":"Epidemiology and social costs of hip fracture","volume":"49","author":"N Veronese","year":"2018","journal-title":"Injury"},{"issue":"06","key":"ref2","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1007\/BF01623184","article-title":"Hip fractures in the elderly: a world-wide projection","volume":"2","author":"C Cooper","year":"1992","journal-title":"Osteoporos Int"},{"issue":"02","key":"ref3","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1007\/s00198-015-3277-9","article-title":"Impact of hip fracture on hospital care costs: a population-based study","volume":"27","author":"J Leal","year":"2016","journal-title":"Osteoporos Int"},{"issue":"09","key":"ref4","doi-asserted-by":"publisher","first-page":"CD004961","DOI":"10.1002\/14651858.CD004961.pub4","article-title":"Intramedullary nails for extracapsular hip fractures in adults","volume":"2014","author":"J M Queally","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"issue":"S 01","key":"ref5","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1097\/BOT.0000000000001063","article-title":"Fracture and Dislocation Classification Compendium-2018","volume":"32","author":"E G Meinberg","year":"2018","journal-title":"J Orthop Trauma"},{"issue":"09","key":"ref6","doi-asserted-by":"publisher","first-page":"CD000093","DOI":"10.1002\/14651858.CD000093.pub5","article-title":"Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults","author":"M J Parker","year":"2010","journal-title":"Cochrane Database Syst Rev"},{"issue":"01","key":"ref7","first-page":"20","article-title":"Improved medial cortical contact for a cephalomedullary nail decreases the risk of failure","volume":"27","author":"M Regling","year":"2014","journal-title":"Proc Bayl Univ Med Cent"},{"issue":"06","key":"ref8","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1097\/BOT.0b013e318162f67f","article-title":"Gamma nails revisited: gamma nails versus compression hip screws in the management of intertrochanteric fractures of the hip: a meta-analysis","volume":"23","author":"M Bhandari","year":"2009","journal-title":"J Orthop Trauma"},{"issue":"06","key":"ref9","doi-asserted-by":"publisher","first-page":"735","DOI":"10.1016\/j.injury.2012.12.010","article-title":"Sliding hip screw versus IM nail in reverse oblique trochanteric and subtrochanteric fractures. A study of 2716 patients in the Norwegian Hip Fracture Register","volume":"44","author":"K Matre","year":"2013","journal-title":"Injury"},{"issue":"09","key":"ref10","doi-asserted-by":"publisher","first-page":"2831","DOI":"10.1007\/s11999-013-2834-9","article-title":"Unstable intertrochanteric femur fractures: is there a consensus on definition and treatment in Germany?","volume":"471","author":"M Knobe","year":"2013","journal-title":"Clin Orthop Relat Res"},{"issue":"05","key":"ref11","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1007\/s00113-007-1248-0","article-title":"[\u201cCutting out\u201d in pertrochanteric fractures\u2013problem of osteoporosis?]","volume":"110","author":"F Bonnaire","year":"2007","journal-title":"Unfallchirurg"},{"issue":"06","key":"ref12","doi-asserted-by":"publisher","first-page":"811","DOI":"10.1007\/s00402-015-2206-x","article-title":"Fracture reduction with positive medial cortical support: a key element in stability reconstruction for the unstable pertrochanteric hip fractures","volume":"135","author":"S M Chang","year":"2015","journal-title":"Arch Orthop Trauma Surg"},{"issue":"08","key":"ref13","doi-asserted-by":"publisher","first-page":"859","DOI":"10.1016\/j.otsr.2014.07.023","article-title":"Proximal femoral nails antirotation, Gamma nails, and dynamic hip screws for fixation of intertrochanteric fractures of femur: A meta-analysis","volume":"100","author":"K-L Ma","year":"2014","journal-title":"Orthop Traumatol Surg Res"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"18195","DOI":"10.1038\/srep18195","article-title":"Internal fixation treatments for intertrochanteric fracture: a systematic review and meta-analysis of randomized evidence","volume":"5","author":"J Yu","year":"2015","journal-title":"Sci Rep"},{"issue":"06","key":"ref15","doi-asserted-by":"publisher","first-page":"469","DOI":"10.5505\/tjtes.2015.28227","article-title":"Comparison of clinical outcomes with three different intramedullary nailing devices in the treatment of unstable trochanteric fractures","volume":"21","author":"S Zehir","year":"2015","journal-title":"Ulus Travma Acil Cerrahi Derg"},{"issue":"23","key":"ref16","doi-asserted-by":"publisher","first-page":"1905","DOI":"10.2106\/JBJS.N.01007","article-title":"Intramedullary versus extramedullary fixation for unstable intertrochanteric fractures: a prospective randomized controlled trial","volume":"97","author":"R Reindl","year":"2015","journal-title":"J Bone Joint Surg Am"},{"issue":"04","key":"ref17","doi-asserted-by":"publisher","first-page":"700","DOI":"10.2106\/JBJS.G.00517","article-title":"Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice. 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A review of 3230 unstable intertrochanteric fractures of the proximal femur","volume":"32","author":"A Tucker","year":"2018","journal-title":"J Orthop Trauma"},{"issue":"01","key":"ref24","doi-asserted-by":"publisher","first-page":"54","DOI":"10.3109\/17453674.2013.878831","article-title":"Similar mortality rates in hip fracture patients over the past 31 years","volume":"85","author":"S Mundi","year":"2014","journal-title":"Acta Orthop"},{"issue":"02","key":"ref25","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1177\/2151458512450707","article-title":"Outcome of the dynamic helical hip screw system for intertrochanteric hip fractures in the elderly patients","volume":"3","author":"N T O'Malley","year":"2012","journal-title":"Geriatr Orthop Surg Rehabil"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"805805","DOI":"10.1155\/2013\/805805","article-title":"Proximal femoral nail versus dynamic hip screw fixation for trochanteric fractures: a meta-analysis of randomized controlled trials","volume":"2013","author":"X Huang","year":"2013","journal-title":"ScientificWorldJournal"},{"issue":"06","key":"ref27","doi-asserted-by":"publisher","first-page":"e659","DOI":"10.1097\/MJT.0000000000000346","article-title":"Comparison of the clinical effectiveness of PFNA, PFLCP, and DHS in treatment of unstable intertrochanteric femoral fracture","volume":"24","author":"S G Huang","year":"2017","journal-title":"Am J Ther"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1016\/j.clinbiomech.2019.11.006","article-title":"The early failure of the gamma nail and the dynamic hip screw in femurs with a wide medullary canal. 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A meta-analysis and meta-regression of over 190,000 patients","volume":"7","author":"L Moja","year":"2012","journal-title":"PLoS One"},{"issue":"11","key":"ref35","doi-asserted-by":"publisher","first-page":"2827","DOI":"10.1007\/s11999-008-0285-5","article-title":"Is a sliding hip screw or im nail the preferred implant for intertrochanteric fracture fixation?","volume":"466","author":"B Aros","year":"2008","journal-title":"Clin Orthop Relat Res"},{"issue":"03","key":"ref36","doi-asserted-by":"publisher","first-page":"470","DOI":"10.2106\/JBJS.F.00679","article-title":"Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation","volume":"89","author":"H Palm","year":"2007","journal-title":"J Bone Joint Surg Am"}],"container-title":["Revista Brasileira de Ortopedia"],"original-title":[],"language":"pt","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0045-1812023.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T00:16:10Z","timestamp":1763511370000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0045-1812023"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8]]},"references-count":36,"journal-issue":{"issue":"04","published-online":{"date-parts":[[2025,11,4]]},"published-print":{"date-parts":[[2025,8]]}},"alternative-id":["s00451812023"],"URL":"https:\/\/doi.org\/10.1055\/s-0045-1812023","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0102-3616","1982-4378"],"issn-type":[{"value":"0102-3616","type":"print"},{"value":"1982-4378","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8]]}}}