Intraoperative and postoperative differences between intramedullary nailing and dynamic hip screw for trochanteric fractures: A trial sequential analysis and GRADE

Introduction: This study aimed to compare the intraoperative and postoperative differences between intramedullary nailing and dynamic hip screw in patients with trochanteric fracture. Method: The search of PubMed, Cochrane Library, Web of Science, and Scopus identified studies comparing IMN and DHS for hip fractures. The quality of the studies was assessed using appropriate tools. Meta-analysis was performed using mean difference, standardized mean difference, log odds-ratio effect sizes and random effect model. The heterogeneity was considered significant if (I² > 50%). Subgroup analysis and meta-regression examined the impact of covariates such as age and gender. Trial Sequential Analysis (TSA) and GRADE assessed the evidence's robustness of the primary outcomes. Results: This meta-analysis of 60 studies, including 88256 patients, resulted in no significant difference in open reduction of fractures (log odds ratio -1.52, p = 0.10), while IMN significantly reduced blood loss by a mean difference of -98.80 ml (p < 0.01) and showed a trend toward fewer blood transfusions (log odds ratio -0.65, p = 0.09). Although screening time was slightly longer for IMN (MD = 0.52 minutes, p < 0.05), surgical time favored IMN with a significant reduction of -9.47 minutes (p < 0.01). Postoperatively, IMN demonstrated a modest reduction in hospital stay (SMD = -0.22, p < 0.01) and a significant improvement in healing time (MD = -6.92 days, p = 0.02). No significant differences were observed in femoral neck shortening or functional outcomes. Conclusion: The existing evidence till now showed IMN offers reduced blood loss and better surgical efficiency, but there are varied results on healing times and hospital stays. Ongoing research is essential for evaluating IMN techniques against DHS methods. Intertrochanteric femur fractures – IMN – DHS – meta-analysis.