Comparison of Intramedullary Nails with Cephalic Screws and Dynamic Hip Screw in the Treatment of Unstable Intertrochanteric Fractures in Adults - A Systematic Review and Meta-Analysis.

Objective: To compare the clinical, functional, and safety outcomes of intramedullary nails with cephalic screws (cephalomedullary nails, CMNs) and the dynamic hip screws (DHSs) in the treatment of unstable intertrochanteric femur fractures (of grades 31-A2/A3 according to the Arbeitsgemeinschaft für Osteosynthesefragen [AO, Association for the Study of Internal Fixation]/Orthopaedic Trauma Association [OTA] and III-V according to the Tronzo classification). Methods: The present systematic review followed the 2020 guidelines of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, with searches on the PubMed, Scopus, Embase, Cochrane, and Web of Science databases. We included comparative studies (randomized controlled trials or prospective cohorts) published from 2000 to 2025. The outcomes included mortality, implant failure, reoperation, and functional scores. We also conducted an analysis through the random effects model, heterogeneity assessment per I 2 , and evidence quality per the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Results: A total of 18 studies were included. The CMN group presented shorter operative time (mean difference [MD] = -12.3 minutes), lower intraoperative bleeding (MD = -88 mL), reduced mechanical failure (odds ratio [OR] = 0.42), and fewer reoperations (OR = 0.58). There were no significant differences regarding the functional scores and mortality. The quality of the evidence was high for operative time and mechanical complications, moderate for reoperation, and low for the functional scores. Conclusion: The CMNs were superior to DHS in multiple clinical outcomes for unstable trochanteric fractures, and they should be considered the treatment of choice, especially in cases of greater instability. However, in resource-limited settings, such as those of the Brazilian public hospitals, DHS remains a viable alternative when used with appropriate technical criteria.