SYSTEMATIC REVIEW article
Front. Surg.
Sec. Orthopedic Surgery
This article is part of the Research TopicInnovations and Advancements in Intramedullary Nailing for Lower Limb Fracture ManagementView all 4 articles
Hemiarthroplasty versus proximal femoral nail fixation in unstable pertrochanteric fractures: an updated systematic review and meta-analysis
Provisionally accepted
- Yancheng Third People's Hospital, Yancheng, China
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Background Pertrochanteric fractures are common and challenging for surgeons, especially in unstable conditions. Proximal femoral nails/nails anti-rotation are well-established surgical instruments treating this, but some report that in unstable situations, hemiarthroplasty benefits patients more. We aim to compare hemiarthroplasty with proximal femoral nails, revealing the difference and thus assisting surgeons with decisions. Methods Online databases were searched for eligible studies. According to the PRISMA guideline we represented the differences in eighteen domains, which were categorized into three branches: function, complication, perioperative condition and mortality. Effect sizes were calculated, and the heterogeneities thereof were analyzed. We tested sensitivity, publication biases, and graded certainty of evidence. At last, comprehensive results were interpreted. Results Twenty-seven studies, with a total of 2517 patients, were included. The hemiarthroplasty transcended nails in early Harris hip scores, full-weight bearing time, and complication rate related to implants. Proximal femoral nails performed better in surgery duration and superficial infection. Final Harris hip scores, general and implant-unrelated complications, mortality, hospital stay, re-operation incidence, bedsore, and deep venous thrombosis indicated that no significant difference existed. Ambulation time, blood loss, and transfusion incidence were identified with potential publication bias. Conclusion Hemiarthroplasty and proximal femoral nails/nails anti-rotation are effective methods for treating unstable pertrochanteric fractures. No clinically important differences, like the re-operation rate procured by the implant-related complications, demonstrate that these two tactics differ in treating unstable pertrochanteric fractures. Surgeons should focus on internal fixations, barring conditions wherein hemiarthroplasty is essential.
Keywords: Hemiarthroplasty, Hip fracture (HFr), Hip surgery, Pertrochanteric fractures, Proximal femoral nail
Received: 07 Jan 2026; Accepted: 31 Jan 2026.
Copyright: © 2026 Zhang, Yuan, Dong and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Chao Wang
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