Are short femoral nails superior to the sliding hip screw? A meta-analysis of 24 studies involving 3,279 fractures

The purpose of this meta-analysis was to compare the fixation outcome between the sliding hip screw (SHS) and intramedullary nails (IMN) in stable and unstable extracapsular proximal femoral fractures. All randomised controlled studies comparing IMNs with a SHS were considered for inclusion. Data was independently extracted and trial methodology assessed. Twenty-four randomised trials involving 3,202 patients with 3,279 fractures were included. Pooled results gave no statistically significant difference in the cut-out rate between the IMN and SHS (41/1,556 vs 37/1,626; relative risk 1.19; 95% confidence interval 0.78-1.82). Total failure rate (1,03/1,495 and 58/1,565, relative risk 1.83; 95% confidence interval 1.35-2.50) and re-operation rate (57/1,357 and 35/1,415, relative risk 1.63; 95% confidence interval 1.11-2.40) were greater with the IMN compared with the SHS. There was no evidence for a reduced failure rate with IMN in unstable trochanteric fractures.