{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T23:05:33Z","timestamp":1790895933921,"version":"4.1.0"},"reference-count":41,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Trochanteric femoral fractures pose significant surgical challenges, particularly in elderly patients. Intramedullary nailing (IMN) and plate fixation (PF) are the primary operative strategies, yet their comparative efficacy and safety remain debated. This meta-analysis synthesizes randomized controlled trials (RCTs) to evaluate clinical, functional, perioperative, and biomechanical outcomes of IMN versus PF specifically in trochanteric fractures. Methods: A systematic search of six databases was conducted up to 20 May 2024, to identify RCTs comparing IMN and PF in adult patients with trochanteric femoral fractures. Data extraction followed PRISMA guidelines, and outcomes were pooled using random-effects models. Subgroup analyses examined the influence of fracture stability, implant type, and patient age. Risk of bias was assessed using the Cochrane RoB 2.0 tool. Results: Fourteen RCTs (n = 4603 patients) were included. No significant differences were found in reoperation rates, union time, implant cut-out, or mortality. IMN was associated with significantly reduced operative time (MD = \u22125.18 min), fluoroscopy time (MD = \u221232.92 s), and perioperative blood loss (MD = \u2212111.68 mL). It also had a lower risk of deep infection. Functional outcomes and anatomical results were comparable. Subgroup analyses revealed fracture stability and nail type significantly modified operative time, and compression screws were associated with higher reoperation rates than IMN. Conclusions: For trochanteric femoral fractures, IMN and PF yield comparable results for most clinical outcomes, with IMN offering some advantages in surgical efficiency and perioperative morbidity, though functional outcomes were comparable. Implant selection and fracture stability influence outcomes, supporting individualized surgical decision making.<\/jats:p>","DOI":"10.3390\/jcm14155492","type":"journal-article","created":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T08:46:55Z","timestamp":1754383615000},"page":"5492","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Intramedullary Nailing vs. Plate Fixation for Trochanteric Femoral Fractures: A Systematic Review and Meta-Analysis of Randomized Trials"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6125-6040","authenticated-orcid":false,"given":"\u00dcmit","family":"Mert","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Trauma Surgery, Helios Wuppertal University Witten\/Herdecke, 42283 Wuppertal, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6374-0626","authenticated-orcid":false,"given":"Maher","family":"Ghandour","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Trauma Surgery, Helios Wuppertal University Witten\/Herdecke, 42283 Wuppertal, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moh\u2019d Yazan","family":"Khasawneh","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Trauma Surgery, Helios Wuppertal University Witten\/Herdecke, 42283 Wuppertal, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filip","family":"Milicevic","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Trauma Surgery, Helios Wuppertal University Witten\/Herdecke, 42283 Wuppertal, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2993-4224","authenticated-orcid":false,"given":"Ahmad","family":"Al Zuabi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Trauma Surgery, Helios Wuppertal University Witten\/Herdecke, 42283 Wuppertal, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klemens","family":"Horst","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH Aachen University, 52056 Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Hildebrand","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH Aachen University, 52056 Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bertil","family":"Bouillon","sequence":"additional","affiliation":[{"name":"Department of Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University Witten\/Herdecke, 51109 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2621-3165","authenticated-orcid":false,"given":"Mohamad Agha","family":"Mahmoud","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Trauma Surgery, Helios Wuppertal University Witten\/Herdecke, 42283 Wuppertal, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1458-2825","authenticated-orcid":false,"given":"Koroush","family":"Kabir","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Trauma Surgery, Helios Wuppertal University Witten\/Herdecke, 42283 Wuppertal, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,4]]},"reference":[{"key":"ref_1","first-page":"46","article-title":"Global, regional, national trends of femur fracture and machine learning prediction: Comprehensive findings and questions from global burden of disease 1990\u20132019","volume":"46","author":"Wu","year":"2024","journal-title":"J. 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