{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T14:34:37Z","timestamp":1790778877473,"version":"4.1.0"},"reference-count":34,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2019,10,29]],"date-time":"2019-10-29T00:00:00Z","timestamp":1572307200000},"content-version":"vor","delay-in-days":28,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["31571235"],"award-info":[{"award-number":["31571235"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["31571236"],"award-info":[{"award-number":["31571236"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["31271284"],"award-info":[{"award-number":["31271284"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2019,10]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the efficacy and safety of hip replacement and intramedullary nails for treating unstable intertrochanteric fractures in elderly patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Randomized clinical trials (RCTs) to compare hip replacement with intramedullary nail in the management of elderly patients with unstable intertrochanteric femur fracture were retrieved from Cochrane Library (up to January 2018), CNKI (China National Knowledge Infrastructure), Wanfang Data, PubMed, and Embase. The methodological quality of the included trials was assessed using the Cochrane risk of bias assessment tool, and relevant data was extracted. Statistical analysis was performed by Revman 5.3. Where possible, we performed the limited pooling of data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fourteen trials including a total of 1067 participants aged 65 and above were included for qualitative synthesis and meta\u2010analysis. The methodological quality of the included study was poor. The meta\u2010analysis indicated that the hip replacement group benefited more than the intramedullary nail group in terms of the bearing load time (WMD \u201014.61, 95% CI \u221221.51 to \u22127.7, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.0001), mechanical complications (OR 0.34, 95% CI 0.21 to 0.57, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.0001), and post\u2010operative complications (OR 0.46, 95% CI 0.22 to 0.93, <jats:italic>P<\/jats:italic> = 0.03). While the intramedullary nail was superior to arthroplasty regarding the intraoperative blood loss (WMD 58.36, 95% CI 30.77 to 85.94, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.0001). However, there were no statistical significances in the length of surgery (WMD 5.27, 95% CI 4.23 to 14.77, <jats:italic>P<\/jats:italic> = 0.28), units of blood transfusion (WMD 0.34, 95% CI \u20100.16 to 0.85, <jats:italic>P<\/jats:italic> = 0.18), length of hospital stay (WMD \u20101.00, 95% CI \u20102.93 to 0.93, <jats:italic>P<\/jats:italic> = 0.31), Harris hip score (WMD 0.31, 95% CI \u20100.39 to 1.01, <jats:italic>P<\/jats:italic> = 0.38), and mortality (OR 1.24, 95% CI 0.12 to 13.10, <jats:italic>P<\/jats:italic> = 0.86).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This systematic review and meta\u2010analysis provided evidence for the efficacy and safety of hip replacement and intramedullary nail in treating unstable intertrochanteric fractures. However, the results should be interpreted cautiously because of methodological limitations and publication bias.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.12532","type":"journal-article","created":{"date-parts":[[2019,10,30]],"date-time":"2019-10-30T00:57:43Z","timestamp":1572397063000},"page":"745-754","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Hip Replacement as Alternative to Intramedullary Nail in Elderly Patients with Unstable Intertrochanteric Fracture: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"11","author":[{"given":"Jia\u2010bao","family":"Ju","sequence":"first","affiliation":[{"name":"Department of Orthopedics and Trauma Peking University People's Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9566-646X","authenticated-orcid":false,"given":"Pei\u2010xun","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Peking University People's Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bao\u2010guo","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Peking University People's Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,10,29]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2013.05.006"},{"key":"e_1_2_6_3_1","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1097\/00003086-199003000-00024","article-title":"The future of hip fractures in the United States Numbers, Costs, and Potential Effects of Postmenopausal Estrogen","volume":"252","author":"Cummings SR","year":"1990","journal-title":"Clin Orthop Relat Res"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-642-61261-9"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.31B2.190"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.11622\/smedj.2016071"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.092220"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.O.00229"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.99B1.BJJ-2016-0134.R1"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.D.02768"},{"key":"e_1_2_6_11_1","first-page":"CD000086","article-title":"Replacement arthroplasty versus internal fixation for extracapsular hip fractures in adults","volume":"2","author":"Parker MJ","year":"2006","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000007446"},{"key":"e_1_2_6_13_1","unstructured":"JPT H S G. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March2011]. The Cochrane Collaboration 2011. Available fromhttp:\/\/handbook.cochrane.org\/. 2011."},{"key":"e_1_2_6_14_1","first-page":"247","article-title":"The efficacy of hip replacement in the elderly adults with unstable intertrochanteric fracture","volume":"10","author":"Chen JF","year":"2012","journal-title":"Qiu Yi Wen Dao"},{"key":"e_1_2_6_15_1","first-page":"45","article-title":"Comparative analysis of femoral head replacement and PNA internal fixation for super elderly patients with intertrochanteric fracture","volume":"13","author":"Huaidong D","year":"2016","journal-title":"Med Innov China"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.25011\/cim.v38i1.22577"},{"key":"e_1_2_6_17_1","first-page":"144","article-title":"Compare the efficacy between PFNA and hip replacement in the femoral interchochanteric fracture","volume":"23","author":"Guo XA","year":"2017","journal-title":"Hei Bei Yi Xue"},{"key":"e_1_2_6_18_1","unstructured":"CNKI. Comparative study of PFNA and hemiarthroplasty in treatment of intertrochanteric fracture in the elderly adults.2015. Available from:https:\/\/dwz.cn\/EDhaRElZ(accessed May 2015)."},{"key":"e_1_2_6_19_1","first-page":"118","article-title":"Comparative study of PFNA and hemiarthroplasty in treatment of elderly adults with unstable intertrochanteric fracture","volume":"20","author":"Su SX","year":"2016","journal-title":"Shi Yong Lin Chuang Yi Yao Za Zhi"},{"key":"e_1_2_6_20_1","first-page":"9640","article-title":"Compara efficacy of hemiarthroplasty and PFNA in treatment of elderly adults with unstable intertrochanteric fracture","volume":"12","author":"Wang WD","year":"2012","journal-title":"Ke Xue Ji Shu Yu Gong Cheng"},{"key":"e_1_2_6_21_1","first-page":"107","article-title":"Application and analysis of the clinic effect of the artificial hip arthroplasty in treatment of elderly intertrochanteric fracture","volume":"13","author":"Wang B","year":"2016","journal-title":"Zhong Guo Yi Yao Dao Bao"},{"key":"e_1_2_6_22_1","first-page":"4619","article-title":"Comparative study of hemiarthroplasty and PFNA in treatment of elderly adults with unstable intertrochanteric fracture","volume":"4","author":"Wang PC","year":"2017","journal-title":"Lin Chuang Yi Yao Wen Xian Za Zhi"},{"key":"e_1_2_6_23_1","first-page":"67","article-title":"Curative effect comparison of artificial joint replacement and internal fixation in the treatment of osteoporotic unstable intertrochanteric fractures in senile patients","volume":"9","author":"Xu XM","year":"2017","journal-title":"Lin Chuang Yi Xue"},{"key":"e_1_2_6_24_1","first-page":"73","article-title":"The efficacy of hemiarthroplasty in treatment of osteoporotic elderly adults with femoral intertrochanteric fracture","volume":"57","author":"Ye M","year":"2017","journal-title":"Shan Dong Yi Yao"},{"key":"e_1_2_6_25_1","first-page":"130","article-title":"Compara the efficacy of PFNA and hemiarthroplasty in treatment of elderly adults with unstable intertrochanteric fracture","volume":"14","author":"Zhao L","year":"2016","journal-title":"Dang Dai Yi Yao Lun Cong"},{"key":"e_1_2_6_26_1","first-page":"2065","article-title":"Compara the efficacy of PFNA and hemiarthroplasty in treatment of elderly adults with unstable intertrochanteric fracture","volume":"32","author":"Zhu ZP","year":"2016","journal-title":"Xian Dai Yi Yao Wei Sheng"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-013-2392-8"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-013-2120-1"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00590-016-1757-z"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2008.02.005"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.1038\/srep18195"},{"key":"e_1_2_6_32_1","first-page":"503","article-title":"Comparison of femur intertrochanteric fracture fixation with hemiarthroplasty and proximal femoral nail systems","volume":"21","author":"Gormeli G","year":"2015","journal-title":"Ulus Travma Acil Cerrahi Derg"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.5371\/hp.2015.27.3.152"},{"key":"e_1_2_6_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2015.05.024"},{"key":"e_1_2_6_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2011.11.008"}],"container-title":["Orthopaedic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/os.12532","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/os.12532","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/os.12532","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,8]],"date-time":"2023-09-08T11:03:52Z","timestamp":1694171032000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/os.12532"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10]]},"references-count":34,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2019,10]]}},"alternative-id":["10.1111\/os.12532"],"URL":"https:\/\/doi.org\/10.1111\/os.12532","archive":["Portico"],"relation":{},"ISSN":["1757-7853","1757-7861"],"issn-type":[{"value":"1757-7853","type":"print"},{"value":"1757-7861","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,10]]},"assertion":[{"value":"2019-03-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-08-15","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-10-29","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}