{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T13:24:44Z","timestamp":1788009884282,"version":"build-2784847793"},"reference-count":49,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Intertrochanteric fractures in the elderly present significant management challenges, with intramedullary (IM) nails increasingly used for fixation. However, the optimal implant type remains debated. Third-generation IM nails, including proximal femoral nail antirotation (PFNA), Gamma 3 (G3), and Intertan (IT), feature helical blades, single lag screws, and dual integrated lag screws, respectively. This meta-analysis evaluates functional outcomes, healing status, and complication rates of intertrochanteric fractures treated with these devices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A systematic review and meta-analysis were conducted using PubMed, Embase, CENTRAL, and Google Scholar until November 2024. Randomized controlled trials (RCTs) and observational comparative studies involving patients older than 65 years were included. Outcomes assessed functional scores, healing status, and complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Twenty-four studies (6 RCTs, 5 prospective cohort studies, and 13 retrospective cohort studies) involving 2,999 patients were analyzed. The G3, IT, and PFNA groups included 617, 1,124, and 1,258 patients, respectively. Results showed similar functional recovery across devices. Perioperative parameters favored PFNA, while IT demonstrated lower complication and revision rates. No outcomes favored G3, suggesting it is interchangeable with other devices. PFNA was easier to use and required shorter operation times but had higher cutout and revision rates. IT, despite longer operation times, promoted faster fracture healing and had fewer complications. G3 did not outperform other devices in any measured outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>PFNA, G3, and IT provide comparable functional outcomes and overall complication rates, making device selection largely dependent on surgeon preference. However, IT may be the superior choice for complex fractures requiring more excellent stability due to its lower complication and revision rates. This analysis highlights the importance of tailoring implant selection to individual patient needs and fracture complexity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.rvw.24.00203","type":"journal-article","created":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T08:33:15Z","timestamp":1743150795000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":7,"title":["Intertrochanteric Fractures in the Elderly Treated with Different Intramedullary Devices"],"prefix":"10.2106","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-1065-8693","authenticated-orcid":false,"given":"Noah David","family":"Miller","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, The University of Toledo Medical Center, Toledo, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7681-5778","authenticated-orcid":false,"given":"Thomas","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, The University of Toledo Medical Center, Toledo, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0637-177X","authenticated-orcid":false,"given":"Laya","family":"Gokula","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, The University of Toledo Medical Center, Toledo, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5895-8276","authenticated-orcid":false,"given":"Jiayong","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, The University of Toledo Medical Center, Toledo, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,3]]},"reference":[{"issue":"1","key":"r1-20250325","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1186\/s12891-016-1333-z","article-title":"Comparison of intramedullary and extramedullary fixation of stable intertrochanteric fractures in the elderly: a prospective randomised controlled trial exploring hidden perioperative blood loss","volume":"17","author":"Cai","year":"2016","journal-title":"BMC Musculoskelet Disord"},{"issue":"10","key":"r2-20250325","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":"Shannon","year":"2019","journal-title":"J Orthop Trauma"},{"issue":"1","key":"r3-20250325","doi-asserted-by":"crossref","first-page":"2321","DOI":"10.1038\/s41598-018-20717-2","article-title":"Comparing the intramedullary nail and extramedullary fixation in treatment of unstable intertrochanteric fractures","volume":"8","author":"Zhang","year":"2018","journal-title":"Sci Rep"},{"issue":"suppl 2","key":"r4-20250325","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1016\/j.injury.2015.05.024","article-title":"Intertrochanteric femur fractures in the elderly treated with either proximal femur nailing or hemiarthroplasty: a prospective randomised clinical study","volume":"46","author":"\u00d6zkay\u0131n","year":"2015","journal-title":"Injury"},{"issue":"6","key":"r5-20250325","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1007\/s00264-009-0826-x","article-title":"Total hip replacement as primary treatment of unstable intertrochanteric fractures in elderly patients","volume":"34","author":"Sidhu","year":"2010","journal-title":"Int Orthop"},{"issue":"4","key":"r6-20250325","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.1177\/147323001003800408","article-title":"A comparison of the proximal femoral nail antirotation device and dynamic hip screw in the treatment of unstable pertrochanteric fracture","volume":"38","author":"Xu","year":"2010","journal-title":"J Int Med Res"},{"issue":"8","key":"r7-20250325","doi-asserted-by":"crossref","first-page":"5065","DOI":"10.1007\/s00402-023-04902-1","article-title":"Extramedullary versus intramedullary fixation of stable trochanteric femoral fractures: a systematic review and meta-analysis","volume":"143","author":"Zeelenberg","year":"2023","journal-title":"Arch Orthop Trauma Surg"},{"issue":"3","key":"r8-20250325","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1302\/0301-620X.74B3.1587874","article-title":"Gamma nails and dynamic hip screws for peritrochanteric fractures. 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