INTRODUCTION Unstable intertrochanteric femoral fractures in the elderly require either fixation or joint sacrificing surgery; proximal femoral nail (PFN) and bipolar hemiarthroplasties (BPH) are the most common interventions. PFN is considered to be the ideal construct for these fractures; however, the usage of hemiarthroplasties to facilitate earlier mobilization has been on a rise. Currently there is no consensus on the superiority of one of these two techniques over the other and the present review was done to determine this. RESEARCH QUESTION Is PFN a better alternative to BPH for unstable intertrochanteric femur fractures in the elderly? OBJECTIVE The present systematic review and meta-analysis was conducted to determine the superiority of PFN over BPH by comparing the primary outcomes like mortality, Harris Hip scores (HHS), complications, and re-operations. Additionally, secondary outcomes like blood loss, duration of surgery, and period of hospital stays were also compared. METHODOLOGY Three databases of PubMed, EMBASE, and SCOPUS were searched for relevant articles that directly compared PFN and BPH in unstable intertrochanteric femur fractures in the elderly. RESULTS We analyzed a total of seven studies published between the years 2005 to 2017. There were four retrospective and three prospective randomized controlled studies. The number of patients in these studies ranged from 53 to 303. PRIMARY OUTCOMES There was a significant difference in HHS between two groups with standard mean difference of - 0.51 (range - 0.67 to -0.36), favouring the PFN group. The rate of mortality was higher in the BPH group with odds ratio of 2.07 (range 1.40-3.08). Implant-related complications like fractures and subsidence were more in BPH group but this was not significant. SECONDARY OUTCOMES Mean surgical time (standard mean difference 2.19) and blood loss (3.75) were significantly less in the PFN group. The duration of hospital stay was also found to be significantly less in the PFN group (2.66). CONCLUSION Proximal femoral nails are superior to bipolar hemiarthroplasties for unstable intertrochanteric femoral fractures in the elderly. PFN imparts better functional outcomes and has lower rates of overall mortality. Additionally it is faster surgery, with lesser blood loss contributing to better results.

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在老年人的AO / OTA A2和A3股骨粗隆间股骨骨折中，股骨近端钉扎术优于半髋置换术：系统的文献综述和荟萃分析。

引言老年人股骨粗隆间不稳定骨折需要进行固定或关节牺牲手术。股骨近端钉（PFN）和双极半髋置换（BPH）是最常见的干预措施。PFN被认为是这些骨折的理想构造。然而，使用半髋关节置换术以促进早期动员的趋势正在增加。目前尚无关于这两种技术中的一种优于另一种技术的共识，并进行了本次综述来确定这一点。研究问题对于老年人不稳定的股骨转子间股骨骨折，PFN是否可以替代BPH？目的通过比较主要结果，例如死亡率，Harris Hip分数（HHS），并发症，并重新手术。此外，还比较了诸如失血，手术时间和住院时间等次要结局。方法研究人员检索了PubMed，EMBASE和SCOPUS的三个数据库，以直接比较老年人不稳定的股骨转子间骨折中PFN和BPH的相关文章。结果我们分析了2005年至2017年之间发表的总共七项研究。其中有四项回顾性研究和三项前瞻性随机对照研究。这些研究的患者人数为53到303。主要结局两组之间的HHS有显着差异，标准平均差异为-0.51（范围-0.67至-0.36），偏爱PFN组。BPH组的死亡率较高，比值比为2.07（范围1.40-3.08）。BPH组骨折，下陷等与植入物相关的并发症较多，但这并不显着。次要结果PFN组的平均手术时间（标准平均差异为2.19）和失血量（3.75）显着减少。PFN组的住院时间也显着减少（2.66）。结论对于老年人不稳定的股骨转子间股骨骨折，股骨近端指甲优于双极半髋置换。PFN具有更好的功能结局，总死亡率较低。此外，手术速度更快，失血更少，效果更好。75）在PFN组中明显较少。PFN组的住院时间也显着减少（2.66）。结论对于老年人不稳定的股骨转子间股骨骨折，股骨近端指甲优于双极半髋置换。PFN具有更好的功能结局，总死亡率较低。此外，手术速度更快，失血更少，效果更好。75）在PFN组中明显较少。PFN组的住院时间也显着减少（2.66）。结论对于老年人不稳定的股骨转子间股骨骨折，股骨近端指甲优于双极半髋置换。PFN具有更好的功能结局，总死亡率较低。此外，手术速度更快，失血更少，效果更好。