{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T20:21:57Z","timestamp":1789676517251,"version":"4.0.1"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2025,5,5]],"date-time":"2025-05-05T00:00:00Z","timestamp":1746403200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Purpose<\/jats:title>\n<jats:p>We aim to evaluate the efficacy and safety of short cephalomedullary nails(CMN) versus long CMN in patients with intertrochanteric femur fractures(IFFs).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>The PubMed, Web of Science, and Embase databases were searched for relevant publications until July 2024. All randomized controlled studies evaluating the efficacy and safety of short CMN versus long CMN in patients with IFFs were included. We estimated the pooled risk ratio (RR) with 95% confidence intervals (CIs) for binary outcomes, and the mean difference (MD) for continuous outcomes.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 7 studies with 658 patients were included in this analysis. There was no significant difference between the short CMN group and the long CMN group in Harris hip score, mortality within 1-year, overall complication rates, or reoperation rates. However, durations of surgery were significantly lower in the short CMN group compared to the long CMN group (MD: \u201221.83 minutes, 95% CI: \u201227.54 minutes, \u201216.13 minutes), along with significantly lower intraoperative blood loss (MD: \u2012136.70\u2009mL, 95% CI: \u2012139.06\u2009mL, \u2012134.34\u2009mL) and tip-apex distance (MD: \u20120.47\u2009cm, 95% CI: \u20120.63\u2009cm, \u20120.31\u2009cm). There was also no significant difference in peri-implant fracture or lengths of hospital stays.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Short CMN are associated with shorter duration of surgery, reduced tip-apex distance, and lower intraoperative blood loss compared to long CMN for the fixation of IFFs. However, there were no significant differences in functional outcomes, overall complication rates, reoperation rates, mortality within one year, peri-implant fracture, or lengths of hospital stays.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0319758","type":"journal-article","created":{"date-parts":[[2025,5,5]],"date-time":"2025-05-05T17:36:21Z","timestamp":1746466581000},"page":"e0319758","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Short versus long cephalomedullary nails for intertrochanteric femur fractures: A meta-analysis of randomized controlled trials"],"prefix":"10.1371","volume":"20","author":[{"given":"Shengquan","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiaofeng","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8882-6620","authenticated-orcid":true,"given":"Haiqun","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,5,5]]},"reference":[{"issue":"7","key":"pone.0319758.ref001","first-page":"e859","article-title":"Effect of distal interlock fixation in stable intertrochanteric fractures","volume":"36","author":"PM Kane","year":"2013","journal-title":"Orthopedics"},{"issue":"5","key":"pone.0319758.ref002","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1007\/PL00004148","article-title":"World-wide projections for hip fracture","volume":"7","author":"B Gullberg","year":"1997","journal-title":"Osteoporos Int"},{"issue":"5","key":"pone.0319758.ref003","first-page":"e636","article-title":"Short-term medical complications following short versus long cephalomedullary nails","volume":"41","author":"J Liu","year":"2018","journal-title":"Orthopedics"},{"issue":"4","key":"pone.0319758.ref004","doi-asserted-by":"crossref","first-page":"792","DOI":"10.2106\/JBJS.I.00508","article-title":"A comparison of the long gamma nail with the sliding hip screw for the treatment of AO\/OTA 31-A2 fractures of the proximal part of the femur: a prospective randomized trial","volume":"92","author":"TM Barton","year":"2010","journal-title":"J Bone Joint Surg Am"},{"key":"pone.0319758.ref005","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1051\/sicotj\/2018023","article-title":"Similar function and complications for patients with short versus long hip nailing for unstable pertrochanteric fractures","volume":"4","author":"IP Galanopoulos","year":"2018","journal-title":"SICOT J"},{"issue":"23","key":"pone.0319758.ref006","doi-asserted-by":"crossref","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":"1","key":"pone.0319758.ref007","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1186\/s13018-020-02193-5","article-title":"Cephalo-medullary nailing versus dynamic hip screw with trochanteric stabilisation plate for the treatment of unstable per-trochanteric hip fractures: a meta-analysis","volume":"16","author":"A Selim","year":"2021","journal-title":"J Orthop Surg Res"},{"issue":"3","key":"pone.0319758.ref008","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1007\/s00402-023-05138-9","article-title":"Extramedullary versus intramedullary fixation of unstable trochanteric femoral fractures (AO type 31-A2): a systematic review and meta-analysis","volume":"144","author":"ML Zeelenberg","year":"2024","journal-title":"Arch Orthop Trauma Surg"},{"issue":"1","key":"pone.0319758.ref009","first-page":"CD000093","article-title":"Cephalomedullary nails versus extramedullary implants for extracapsular hip fractures in older adults","volume":"1","author":"SR Lewis","year":"2022","journal-title":"Cochrane Database Syst Rev"},{"issue":"2","key":"pone.0319758.ref010","doi-asserted-by":"crossref","first-page":"954","DOI":"10.22271\/ortho.2019.v5.i2n.1463","article-title":"A comparative prospective study of osteosynthesis in intertrochanteric fractures, using dynamic hip screw (DHS) and proximal femoral nailing (PFN)","volume":"5","author":"P Kamboj","year":"2019","journal-title":"Int J Orthop Sci"},{"issue":"4","key":"pone.0319758.ref011","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1302\/0301-620X.103B.BJJ-2020-1490.R1","article-title":"Intramedullary nailing versus sliding hip screw for A1 and A2 trochanteric hip fractures","volume":"103-B","author":"JJ Mellema","year":"2021","journal-title":"Bone Joint J"},{"issue":"9","key":"pone.0319758.ref012","doi-asserted-by":"crossref","first-page":"2768","DOI":"10.1007\/s11999-013-2948-0","article-title":"Which implant is better for treating reverse obliquity fractures of the proximal femur: a standard or long nail?","volume":"471","author":"G Okcu","year":"2013","journal-title":"Clin Orthop Relat Res"},{"issue":"5","key":"pone.0319758.ref013","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1016\/j.otsr.2017.04.003","article-title":"Long and short intramedullary nails for fixation of intertrochanteric femur fractures (OTA 31-A1, A2 and A3): A systematic review and meta-analysis","volume":"103","author":"Y Zhang","year":"2017","journal-title":"Orthop Traumatol Surg Res"},{"issue":"8","key":"pone.0319758.ref014","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1007\/s43465-023-00915-5","article-title":"Comparison of Outcomes of long versus short cephalomedullary nails for the fixation of intertrochanteric femur fractures: a systematic review and Meta-analysis of 14,547 Patients","volume":"57","author":"RK Rajnish","year":"2023","journal-title":"Indian J Orthop"},{"issue":"1","key":"pone.0319758.ref015","doi-asserted-by":"crossref","first-page":"106","DOI":"10.3892\/etm.2021.11029","article-title":"Short vs. long intramedullary nail systems in trochanteric fractures: A randomized prospective single center study","volume":"23","author":"\u0218erban Dragosloveanu","year":"2022","journal-title":"Experimental and Therapeutic Medicine"},{"key":"pone.0319758.ref016","first-page":"1144","article-title":"Short proximal femoral nail A2 vs. long proximal femoral nail A2 for the management of intertrochanteric fractures in elderly","volume":"7","author":"SK Sahu","year":"2020","journal-title":"Eur J Mol Clin Med"},{"issue":"4","key":"pone.0319758.ref017","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1097\/BOT.0000000000001409","article-title":"Short Versus Long InterTAN Fixation for Geriatric Intertrochanteric Hip Fractures: A Multicentre Head-to-Head Comparison","volume":"33","author":"M Sellan","year":"2019","journal-title":"J Orthop Trauma"},{"issue":"10","key":"pone.0319758.ref018","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1097\/BOT.0000000000001553","article-title":"Short Versus Long Cephalomedullary Nails for Pertrochanteric Hip Fractures: A Randomized Prospective Study","volume":"33","author":"SF Shannon","year":"2019","journal-title":"J Orthop 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Murad","year":"2019","journal-title":"BMJ"},{"issue":"11","key":"pone.0319758.ref022","doi-asserted-by":"crossref","first-page":"1601","DOI":"10.1002\/sim.1189","article-title":"Bayesian random effects meta-analysis of trials with binary outcomes: methods for the absolute risk difference and relative risk scales","volume":"21","author":"DE Warn","year":"2002","journal-title":"Stat Med"},{"issue":"29","key":"pone.0319758.ref023","doi-asserted-by":"crossref","first-page":"6093","DOI":"10.1002\/sim.3428","article-title":"The exact distribution of Cochran\u2019s heterogeneity statistic in one-way random effects meta-analysis","volume":"27","author":"BJ Biggerstaff","year":"2008","journal-title":"Stat Med"},{"issue":"5","key":"pone.0319758.ref024","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1093\/ije\/dyn204","article-title":"Commentary: Heterogeneity in meta-analysis should be expected and appropriately quantified","volume":"37","author":"JP Higgins","year":"2008","journal-title":"Int J Epidemiol"},{"key":"pone.0319758.ref025","article-title":"How to read a funnel plot in a meta-analysis","volume":"351","author":"P Sedgwick","year":"2015","journal-title":"BMJ"},{"issue":"2","key":"pone.0319758.ref026","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1016\/j.injury.2022.11.037","article-title":"Complications of standard versus long cephalomedullary nails in the treatment of unstable extracapsular proximal femoral fractures: A randomized controlled trial","volume":"54","author":"D Mart\u00ed-Gar\u00edn","year":"2023","journal-title":"Injury"},{"key":"pone.0319758.ref027","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jor.2020.08.030","article-title":"Short or long intramedullary devices for hip fracture? 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