Extramedullary versus intramedullary fixation of stable trochanteric femoral fractures: a systematic review and meta-analysis

Miliaan L. Zeelenberg, Leendert H.T. Nugteren, STABLE-HIP Study Group, A. Cornelis Plaisier, Sverre A.I. Loggers, Pieter Joosse, Dennis Den Hartog, Michael H.J. Verhofstad, Esther M.M. van Lieshout*, Taco Gosens, Johannes H. Hegeman, Suzanne Polinder, Rudolf W. Poolman, Hanna C. Willems, Rutger G. Zuurmond

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

1 Citation (Scopus)
22 Downloads (Pure)


Objective: This systematic review and meta-analysis compared extramedullary fixation and intramedullary fixation for stable two-part trochanteric femoral fractures (AO type 31-A1) with regards to functional outcomes, complications, and surgical outcomes. Methods: Embase, Medline, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar were searched for randomized controlled trials (RCTs) and observational studies. Effect estimates were pooled across studies using random effects models. Results were presented as weighted risk ratio (RR) or weighted mean difference (MD) with corresponding 95% confidence interval (95% CI). Results: Five RCTs (397 patients) and 14 observational studies (21,396 patients) were included. No significant differences in functional outcomes, complications, or surgical outcomes were found between extramedullary and intramedullary fixation devices, except for a difference in duration of surgery (MD 14.1 min, CI 5.76–22.33, p < 0.001) and intra-operative blood loss (MD 92.30 mL, CI 13.49–171.12, p = 0.02), favoring intramedullary fixation. Conclusion: Current literature shows no meaningful differences in complications, surgical, or functional outcomes between extramedullary and intramedullary fixation of stable two-part trochanteric femoral fractures. Both treatment options result in good outcomes. This study implicates that, costs should be taken into account when considering implants or comparing fixation methods in future research.

Original languageEnglish
Pages (from-to)5065-5083
Number of pages19
JournalArchives of Orthopaedic and Trauma Surgery
Issue number8
Early online date2 May 2023
Publication statusPublished - Aug 2023

Bibliographical note

Funding Information:
STABLE-HIP Study Group: Taco Gosens, MD PhD, Department of Orthopedics, Elisabeth-TweeSteden Hospital (ETZ), Tilburg, The Netherlands; Johannes H. Hegeman, MD PhD, Department of Surgery, Zorg Groep Twente (ZGT), Almelo, The Netherlands; Suzanne Polinder, PhD, Department of Public Health, Erasmuc MC, Rotterdam, The Netherlands; Rudolf W. Poolman, MD PhD, Department of Orthopedics, OLVG Hospital, Amsterdam, The Netherlands; Hanna C. Willems, MD PhD, Department of Geriatrics, Amsterdam University Medical Center, Amsterdam, The Netherlands; Rutger G. Zuurmond, MD PhD, Department of Orthopedics, Isala Hospital, Zwolle, The Netherlands

Publisher Copyright:
© 2023, The Author(s).


Dive into the research topics of 'Extramedullary versus intramedullary fixation of stable trochanteric femoral fractures: a systematic review and meta-analysis'. Together they form a unique fingerprint.

Cite this