Intertrochanteric fractures treated with proximal femoral bionic nail versus proximal femoral nail antirotation versus InterTan Nail: A meta-analysis.

Abstract

Intertrochanteric fractures, common in the elderly, are often treated with intramedullary (IM) nails. The comparison of outcomes for different IM nails has not been thoroughly evaluated. This meta-analysis compares postoperative outcomes of PFNA, InterTan, and the newer PFBN. PubMed, Embase, and Google Scholar were searched until April 2025. Comparative studies evaluating ≥2 IM nails reporting key outcomes were included. Outcomes included union/weight-bearing/hospital stay times, operative time, blood loss, complications (delayed/non-union, hardware failure, infections, deep vein thrombosis, femoral head necrosis, screw cutout), and Harris Hip Score (HHS) at 6/12 months. Analyses used Review Manager 5.4: mean difference (MD) for continuous variables (inverse variance) and risk ratio (RR) for dichotomous variables (Mantel-Haenszel). Significance: <i>P</i> ≤ 0.05. Twenty-six studies, involving 2690 patients, were analyzed. When comparing PFBN to PFNA, PFBN had shorter union (<i>P</i> = 0.01) and weight-bearing times (<i>P</i> = 0.003), but longer operative time (<i>P</i> = 0.003). When comparing PFBN to InterTan<b>,</b> PFBN showed superiority in union (<i>P</i> < 0.001), weight-bearing (<i>P</i> < 0.001), hospital stay (<i>P</i> < 0.001), operative time (<i>P</i> < 0.001), blood loss (<i>P</i> < 0.001), and HHS at 6 (<i>P</i> = 0.003) and 12 months (<i>P</i> = 0.009). When comparing PFNA to InterTan, InterTan had shorter union (<i>P</i> = 0.001) and weight-bearing (<i>P</i> = 0.03) times, fewer screw cutouts (<i>P</i> < 0.001); PFNA had shorter operative time (<i>P</i> = 0.002) and less blood loss (<i>P</i> = 0.004). Secondary analysis of unstable fractures yielded similar results. PFBN demonstrates superior postoperative outcomes compared to PFNA and InterTan. Further studies comparing PFBN with other IM nails are needed to establish optimal clinical use. 3.