Clinical effects and safety of proximal femur bionic nail versus proximal femoral nail anti-rotation and InterTAN for the treatment of intertrochanteric femoral fracture: a systematic review and meta-analysis

Clinical effects and safety of proximal femur bionic nail versus proximal femoral nail anti-rotation and InterTAN for the treatment of intertrochanteric femoral fracture: a systematic review and meta-analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical effects and safety of proximal femur bionic nail versus proximal femoral nail anti-rotation and InterTAN for the treatment of intertrochanteric femoral fracture: a systematic review and meta-analysis Yulin Ma, Wenbin Zhang, Feilong Lu, Hao Song, Xiaoming Du, Zhaoxi Yang, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5336804/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To compare the clinical effects and safety of the proximal femur bionic nail (PFBN) with those of proximal femoral nail anti-rotation (PFNA) and InterTAN for the treatment of intertrochanteric femoral fracture (IFF). Methods Studies comparing the clinical efficacy of PFBN with that of PFNA and InterTAN in the treatment of IFF published before August 2024 in the PubMed, Embase, Web of Science, Cochrane, CNKI, Wanfang, and VIP databases were retrieved. After the research data were extracted, Review Manager 5.4 (RevMan 5.4) was used for data analysis. Results A total of 13 studies involving 825 patients were included. The meta-analysis results indicated that the PFBN group had advantages over the control group in terms of the postoperative partial and full weight-bearing time, fracture healing time, fracture reduction quality, hospital stay, visual analog scale (VAS) score, and postoperative complication rate (partial weight-bearing time: standardized mean difference ( SMD ) = -3.06, 95% confidence interval ( CI ) -4.02~-2.09, P < 0.00001; full weight-bearing time: SMD = -1.78, 95% CI -2.86~-0.70, P = 0.001; fracture healing time: SMD = -0.55, 95% CI -0.82~-0.28, P < 0.0001; fracture reduction quality: relative risk ( RR ) = 1.07, 95% CI 1.01 ~ 1.13, P = 0.02; hospital stay: SMD = -0.16, 95% CI -0.33 ~ 0.00, P = 0.05; postoperative VAS score: SMD = -0.54, 95% CI -0.90~-0.18, P = 0.003; postoperative complication rate: RR = 0.36, 95% CI 0.21 ~ 0.61, P = 0.0001). There was no significant difference between the two groups in terms of intraoperative blood loss, operation duration, postoperative hip range of motion, postoperative Harris score, intraoperative fluoroscopy time, or incision length (intraoperative blood loss: SMD = -0.57, 95% CI -1.16 ~ 0.02, P = 0.06; operation duration: SMD = 0.28, 95% CI -0.20 ~ 0.76, P = 0.26; postoperative flexion and extension motion: SMD = 0.28, 95% CI -0.18 ~ 0.73, P = 0.23; postoperative rotational motion: SMD = 0.20, 95% CI -0.25 ~ 0.66, P = 0.38; postoperative Harris score: SMD = 0.32, 95% CI 0.00 ~ 0.64, P = 0.05; intraoperative fluoroscopy time: SMD = 0.84, 95% CI -0.24 ~ 1.92, P = 0.13; incision length: SMD = 0.23, 95% CI -0.44 ~ 0.89, P = 0.50). Conclusion For the treatment of IFF, the PFBN is more effective and has a lower risk than the PFNA and InterTAN. Intertrochanteric femoral fracture Proximal femur bionic nail Proximal femoral nail anti-rotation InterTAN PFBN PFNA Meta-analysis Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Introduction Intertrochanteric femoral fracture (IFF) is among the most prevalent types of hip fractures. Projections suggest that by 2050, the global incidence of hip fractures will increase to 4.5-6 million annually, with IFF accounting for more than 50% of these cases [1- 2] . This condition tends to occur in elderly individuals and is characterized by a high rate of complications and mortality. Research indicates that the 6-month mortality rate for IFF in elderly patients is 7.6%, increasing to 13.9% within the first year and potentially reaching as high as 28.5% within 2 years [3] . Therefore, this disease is also known as the "last fracture of life". With increasing age, its incidence increases annually [4] . Currently, the primary treatment approaches for IFF are categorized into intramedullary and extramedullary fixation. Intramedullary fixation is often preferred by clinicians because of its ability to minimize tissue disruption and high mechanical stability. The primary methods for intramedullary fixation, including proximal femoral nail anti-rotation (PFNA), the Gamma nail, and InterTAN, are not without flaws, particularly concerning the quality of fracture reduction and the rate of postoperative complications [5- 6] . These concerns are especially pertinent in the context of unstable fractures, such as the reverse intertrochanteric type [7- 9] . In view of these aspects, in recent years, many theories, such as "lever-balance-reconstruction" theory [10- 11] , "triangular support fixation" theory [12] , "Zhang's N-triangle" theory [13] , and "triangular mechanical reconstruction of the proximal femur" [14] , have been proposed to solve the current dilemma. In accordance with these theories, Professor Zhang Dianying's team proposed the proximal femur bionic nail (PFBN) system. On the basis of these theories, PFBN adds a transverse interlocking support screw to the proximal end of the main nail, and the transverse screw, main nail and the anti-rotation screw form a stable triangular cross structure in the proximal femur, which significantly increases the stability and fixation strength of the proximal femur fracture. This design plays an anti-rotation role, lowers complication rates, and promotes fracture healing and early weight-bearing activity [16- 17] . As a treatment strategy for IFF, PFBN is gaining attention for its ability to improve fracture reduction quality, promote healing, and enable early postoperative mobilization. Some clinical studies [18 -19] highlight the potential clinical advantages of PFBN in promoting IFF healing and early activity without increasing the incidence of complications or surgical risks; however, this perspective lacks a comprehensive evaluation. Consequently, this study is the first comprehensive analysis of the clinical efficacy and safety of PFBN compared with PFNA and InterTAN in the treatment of IFF, aiming to provide evidence-based medical support for the clinical application of PFBN in IFF treatment. Materials and methods The study was conducted according to our preregistered protocol on PROSPERO and the guidance of the PRISMA statement [20] . The PROSPERO registration number for this study is CRD42024549360 . 1.1 Inclusion and exclusion criteria 1.1.1 Inclusion criteria : (1) Study type: clinical controlled study; (2) Study population: patients diagnosed with IFF requiring surgical treatment; (3) Interventions: the intervention group was treated with PFBN, whereas the control group was treated with PFNA or InterTAN; (4) Outcome: included at least one or more of the following: partial weight bearing time, full weight bearing time, fracture healing time, fracture reduction quality, Harris scale, hospital stay, operation duration, intraoperative blood loss, postoperative complication rate, femoral neck–shaft angle, tip–apex distance, hip range of motion, VAS scale, etc. 1.1.2 Exclusion criteria : (1) studies with incomplete data for analysis; (2) full texts not available; and (3) duplicate studies. 1.2 Search strategy A search was conducted in databases including PubMed, WOS, Embase, Cochrane, CNKI, Wanfang, and VIP for clinically controlled studies on the treatment of intertrochanteric femoral fracture (IFF) with PFBN published prior to August 2024. "Proximal femur bionic nail" and "PFBN" were used as search terms. The search strategy is shown in Supplementary Appendix 1. 1.3 Literature screening and data extraction After the studies were retrieved, they were imported into EndNote, and duplicate references were removed. Two researchers (Zhang and Ma) independently screened the literature on the basis of the inclusion and exclusion criteria. The titles and abstracts of the remaining studies were read after removing duplicates and preliminarily excluding irrelevant studies, after which the full texts of the remaining studies were read. Finally, data from the literature, including basic features of the literature (author names, country, publication year, etc.) and the patients (intervention and control measures, sample size, sex ratio, age, follow-up time, etc.), trial results, and quality assessment methods, were extracted. In the case of any disagreements, a third researcher assessed and made the final decision. After the extraction was complete, the data were entered into RevMan 5.4 software for analysis. 1.4 Quality evaluation of the literature The quality of cohort studies was assessed according to the Newcastle‒Ottawa Quality Assessment Scale (NOS) [ 21 ] . A funnel plot was used to assess the presence of publication bias in the included studies. 1.5 Statistical methods Data analysis was performed via Review Manager 5.4 (RevMan 5.4) software. Binary variables are expressed as the relative risk ( RR ) and 95% confidence interval ( CI ), whereas continuous variables are expressed as the standardized mean difference ( SMD ) and 95% CI. For heterogeneity testing, the chi-square test and I² test were used. When I² ≤ 50% and P ≥ 0.1, low heterogeneity was indicated, and a fixed effects model was selected. Conversely, if I² >50% or P < 0.1, high heterogeneity was suggested. If the source of heterogeneity could not be identified, a random effects model was chosen for analysis, and sensitivity analysis was conducted when necessary. A difference was considered statistically significant when P < 0.05. Results 2.1 Literature search results In the initial assessment, 137 studies were identified. Following a rigorous preliminary review, the full-text examination led to the retention of 13 studies that met the inclusion criteria of this research [ 18 – 19 , 22 – 32 ] . Notably, all 13 retained studies had a cohort design. The literature screening process is depicted in Fig. 1 . A total of 13 studies with 825 patients were included, of which 339 were treated with PFBN, 393 with PFNA, and 93 with InterTAN. The essential characteristics of the studies included in this study are provided in Table 1 . Table 1 Basic characteristics of the included studies Author(Year) Group Sample Size (F/M) Mean age (years old) Outcome NOS Fu HP(2023) [ 22 ] PFBN PFNA InterTAN 18(10/8) 36(24/12) 14(9/5) 76.0 ± 4.8 79.7 ± 7.8 81.4 ± 7.6 (1)(3)(5)(10) 9 Jin LK(2024) [ 23 ] PFBN PFNA InterTAN 25(16/9) 55(38/17) 40(26/14) 73.67 ± 5.16 74.23 ± 5.57 73.45 ± 5.34 (1)(3)(5)(7)(8)(9)(10)(15) 9 Liu PY(2023) [ 18 ] PFBN PFNA 35(15/20) 37(15/22) 71.81 ± 7.63 72.33 ± 6.47 (1)(2)(3)(4)(5)(7)(8)(9)(10)(14)(15) 8 Long ZM(2022) [ 24 ] PFBN PFNA 20(9/11) 60(21/39) 63.57 ± 6.84 63.29 ± 5.84 (1)(3)(4)(5)(7)(8)(9)(10) 8 Lin F (2023) [ 25 ] PFBN PFNA 28(16/12) 28(18/10) 70.4 ± 7.8 73.0 ± 8.9 (3)(4)(5)(7)(9)(10) 8 Li ZT (2022) [ 26 ] PFBN PFNA 46(24/22) 46(26/20) 75.7 ± 5.2 75.3 ± 4.2 (1)(4)(5)(7)(8)(9)(10) 8 Lin D (2022) [ 27 ] PFBN PFNA 20(14/6) 25(18/7) 78.7 ± 5.9 78.7 ± 8.2 (2)(3)(5)(7)(9)(10)(12)(13) 9 Zhang RB (2022) [ 28 ] PFBN PFNA 32(13/19) 32(12/20) 79.24 ± 1.23 79.17 ± 1.21 (1)(8)(9)(10) 7 Yang DS (2023) [ 19 ] PFBN PFNA 24(13/11) 24(15/9) 79.0 ± 5.0 78.6 ± 5.8 (1)(3)(4)(6)(7)(8)(9)(10) 8 Wang YC (2023) [ 29 ] PFBN PFNA 20(11/9) 20(12/8) 75.3 ± 6.4 74.6 ± 6.0 (1)(2)(5)(6)(8)(9)(10)(11)(12)(15) 8 Wu YX (2023) [ 30 ] PFBN PFNA 30(13/17) 30(12/18 69.4 ± 3.5 69.6 ± 3.2 (3)(5)(7)(9)(10) 8 Wan Y (2024) [ 31 ] PFBN InterTAN 16(11/5) 19(15/4) 78.0 ± 8.8 75.3 ± 7.0 (1)(2)(5)(6)(8)(9)(10)(11)(13)(14)(15) 9 Jia C (2024) [ 32 ] PFBN InterTAN 25(17/8) 20(13/7) 83.28 ± 7.85 79.90 ± 9.60 (1)(2)(3)(4)(5)(7)(8)(9)(10)(14) 9 Note : (1) Partial weight bearing time; (2) Full weight bearing time; (3) Fracture healing time; (4) Fracture reduction quality; (5) Harris scale; (6) VAS; (7) Postoperative complication rate; (8) Hospital stay; (9) Intraoperative blood loss; (10) Operation duration; (11) Hip range of motion; (12) Femoral neck-shaft angle; (13) Tip-apex distance; (14) Intraoperative fluoroscopy times; (15) Incision length. 2.2 Quality assessment results Among the included cohort studies, exposure determination and cohort selection were distinct and comparable, with no pre-existing outcomes. The outcome index measurement method was suitable. Seven studies [18–19,24−26,29–30] reported follow-up periods of less than one year. One study [ 28 ] did not detail the follow-up times or procedures and thus was not scored. All studies scored over 7 on the NOS scale, ensuring quality. 2.3 Meta-analysis results A summary of the meta-analysis results is shown in Table 2 . Table 2 Summary of the meta-analysis results of the included studies Outcome Subgroup Heterogeneity test Effect models Meta-analysis results I 2 P SMD/RR 95%CI P Partial weight bearing time a PFNA 95% < 0.00001 R -3.36 [-4.46, -2.26] < 0.00001 InterTAN 95% < 0.00001 -2.24 [-4.39, -0.09] 0.04 Overall 95% < 0.00001 -3.06 [-4.02, -2.09] < 0.00001 Full weight bearing time a PFNA 91% < 0.0001 R -1.61 [-2.88, -0.33] 0.01 InterTAN / / -2.34 [-3.23, -1.46] < 0.00001 Overall 89% < 0.00001 -1.78 [-2.86, -0.70] 0.001 Fracture healing time a PFNA 74% 0.0002 R -0.50 [-0.84 -0.16] 0.004 InterTAN 0% 0.84 -0.72 [-1.06, -0.37] < 0.0001 Overall 66% 0.0007 -0.55 [-0.82, -0.28] < 0.0001 Fracture reduction quality a PFNA 65% 0.01 R 1.08 [1.01, 1.16] 0.02 InterTAN 0% 0.56 1.01 [0.89, 1.15] 0.87* Overall 47% 0.07 1.07 [1.01, 1.13] 0.02 Harris scale a PFNA 72% 0.004 R 0.42 [0.01, 0.83] 0.05 InterTAN 51% 0.13 0.10 [-0.38, 0.59] 0.68* Overall 67% 0.002 0.32 [0.00, 0.64] 0.05* VAS scale PFNA 0% 0.65 F -0.69 [-1.13, -0.26] 0.002 InterTAN / / -0.18 [-0.84, 0.49] 0.60* Overall 0% 0.40 -0.54 [-0.90, -0.18] 0.003 Postoperative complication rate PFNA 0% 0.99 F 0.31 [0.17, 0.58] 0.0002 InterTAN 0% 0.76 0.58 [0.21, 1.60] 0.30* Overall 0% 0.98 0.36 [0.21, 0.61] 0.0001 Hospital stay PFNA 59% 0.02 F -0.16 [-0.35, 0.03] 0.09* InterTAN 0% 0.87 -0.17 [-0.50, 0.16] 0.31* Overall 40% 0.09 -0.16 [-0.33, 0.00] 0.05 Intraoperative blood loss a PFNA 94% < 0.00001 -0.78 [-1.53, -0.03] 0.04 InterTAN 68% 0.04 R 0.04 [-0.57, 0.64] 0.90* Overall 93% < 0.00001 -0.57 [-1.16, 0.02] 0.06* Operation duration a PFNA 93% < 0.00001 R 0.24 [-0.37, 0.85] 0.44* InterTAN 80% 0.002 0.37 [-0.34, 1.08] 0.31* Overall 91% < 0.00001 0.28 [-0.20, 0.76] 0.26* Hip range of motion Flexion and extension 0% 0.53 F 0.28 [-0.18, 0.73] 0.23* Rotation 0% 0.80 F 0.20 [-0.25, 0.66] 0.38* Femoral neck-shaft angle a PFNA 78% 0.03 R -0.01 [-0.93, 0.92] 0.99* InterTAN 0% 0.71 0.65 [0.20, 1.10] 0.005 Overall 67% 0.03 0.32 [-0.23, 0.87] 0.25* Tip-apex distance PFNA / / F -0.49 [-1.08, 0.11] 0.11* InterTAN / / -0.90 [-1.61, -0.20] 0.01 Overall 0% 0.37 -0.66 [-1.12, -0.21] 0.004 Intraoperative fluoroscopy times a PFNA 94% < 0.0001 R 0.82 [-1.00, 2.63] 0.38* InterTAN 94% < 0.0001 0.89 [-1.23, 3.02] 0.41* Overall 91% < 0.00001 0.84 [-0.24, 1.92] 0.13* Incision length a PFNA 89% 0.0001 R 0.26 [-0.67, 1.19] 0.59* InterTAN 91% 0.001 0.21 [-1.23, 1.65] 0.78* Overall 86% < 0.00001 0.23 [-0.44, 0.89] 0.50* Note : a : The results of the sensitivity analysis were stable, and the results of the random effects analysis were acceptable; * : No significant difference between the two groups. R : Random effects model; F : Fixed effects model. 2.3.1 Partial weight bearing time A total of 9 studies [18–19,22−24,26,28–29,31] reported partial weight-bearing time after surgery. The results revealed that the partial weight-bearing time in the PFBN group was significantly shorter than that in the control group (PFNA: SMD = -3.36, 95% CI -4.46~-2.26, P < 0.00001; InterTAN: SMD = -2.24, 95% CI -4.39~-0.09, P = 0.04; Overall: SMD = -3.06, 95% CI -4.02~-2.09, P < 0.00001). As shown in Table 2 and Fig. 2 . 2.3.2 Full weight bearing time Four studies [ 18 , 27 , 29 , 31 ] reported the full weight-bearing time after surgery, with the PFBN group showing a significantly shorter duration than the control group did (PFNA: SMD = -1.61, 95% CI -2.88~-0.33, P = 0.01; InterTAN: SMD = -2.34, 95% CI -3.23~-1.46, P < 0.00001; Overall: SMD = -1.78, 95% CI -2.86~-0.70, P = 0.001). As shown in Table 2 and Fig. 3 . 2.3.3 Fracture healing time A total of 10 studies [18–19,22−27,30,32] reported fracture healing times. The results revealed that the fracture healing time in the PFBN group was significantly shorter than that in the control group (PFNA: SMD = -0.50 95% CI -0.84~-0.16, P = 0.004; InterTAN: SMD = -0.72, 95% CI -1.06~-0.37, P < 0.0001; Overall: SMD = -0.55, 95% CI -0.82~-0.28, P < 0.0001). As shown in Table 2 and Fig. 4 . 2.3.4 Fracture reduction quality Eight studies [18,24–26,29−32] reported the fracture reduction quality, that is, the rates of good and excellent reduction quality. The results revealed that the quality of fracture reduction in the PFBN group was greater than that in the control group, and the difference was statistically significant (PFNA: RR = 1.08, 95% CI 1.01 ~ 1.16, P = 0.02; InterTAN: RR = 1.01, 95% CI 0.89 ~ 1.15, P = 0.87; Overall: RR = 1.07, 95% CI 1.01 ~ 1.13, P = 0.02). As shown in Table 2 and Fig. 5 . 2.3.5 Postoperative hip Harris score Eight studies [ 18 , 23 , 25 , 27 , 29 – 32 ] reported postoperative hip Harris scores, although the score in the control group was lower than that in the PFBN group was, the difference was not statistically significant (PFNA: SMD = 0.42, 95% CI 0.01 ~ 0.83, P = 0.05; InterTAN: SMD = 0.10, 95% CI -0.38 ~ 0.59, P = 0.68; Overall: SMD = 0.32, 95% CI 0.00 ~ 0.64, P = 0.05). As shown in Table 2 and Fig. 6 . 2.3.6 Postoperative VAS score A total of 3 studies [ 19 , 29 , 31 ] reported postoperative VAS scores. The results revealed that the postoperative VAS score in the PFBN group was significantly lower than that in the control group (PFNA: SMD = -0.69, 95% CI -1.13~-0.26, P = 0.002; InterTAN: SMD = -0.18, 95% CI -0.84 ~ 0.49, P = 0.60; Overall: SMD = -0.54, 95% CI -0.90~-0.18, P = 0.003). As shown in Table 2 and Fig. 7 . 2.3.7 Postoperative complication rate (safety assessment) A total of 7 studies [ 18 – 19 , 23 , 25 , 28 , 30 , 32 ] reported postoperative complication rates, known as safety assessments. The results revealed that the postoperative complication rate in the PFBN group was significantly lower than that in the control group (PFNA: RR = 0.31, 95% CI 0.17 ~ 0.58, P = 0.0002; InterTAN: RR = 0.58, 95% CI 0.21 ~ 1.60, P = 0.30; Overall: RR = 0.36, 95% CI 0.21 ~ 0.61, P = 0.0001). Thus, to a certain extent, patients with IFF are relatively safer in choosing PFBN treatment. As shown in Table 2 and Fig. 8 . 2.3.8 Hospital stay Nine studies [18–19,23−24,26,28–29,31−32] reported the duration of hospital stay. The results indicated that while the PFBN group had shorter hospital stays than did the control group did, the difference was statistically significant (PFNA: SMD = -0.16, 95% CI -0.35 ~ 0.03, P = 0.09; InterTAN: SMD = -0.17, 95% CI -0.50 ~ 0.16, P = 0.31; Overall: SMD = -0.16, 95% CI -0.33 ~ 0.00, P = 0.05). As shown in Table 2 and Fig. 9 . 2.3.9 Intraoperative blood loss Twelve studies [18–19,23−32] reported intraoperative blood loss. The findings revealed that the PFBN group experienced less bleeding than the PFNA group did, and the difference was statistically significant (PFNA: SMD = -0.78, 95% CI -1.53~-0.03, P = 0.04). However, compared with the InterTAN group and the overall control group, the differences were not statistically significant (InterTAN: SMD = 0.04, 95% CI -0.57 ~ 0.64, P = 0.90; Overall: SMD = -0.57, 95% CI -1.16 ~ 0.02, P = 0.06). As shown in Table 2 and Fig. 10 . 2.3.10 Operation duration A total of 13 studies [18–19,22−32] reported the operation duration. Although the operation duration in the control group was shorter than that in the PFBN group, the difference was not statistically significant (PFNA: SMD = 0.24, 95% CI -0.37 ~ 0.85, P = 0.44; InterTAN: SMD = 0.37, 95% CI - 0.34 ~ 1.08, P = 0.31; Overall: SMD = 0.28, 95% CI -0.20 ~ 0.76, P = 0.26). As shown in Table 2 and Fig. 11 . 2.3.11 Other indicators In terms of other indicators, the analysis results revealed that, except for tip‒apex distance ( SMD = -0.66, 95% CI -1.12~-0.21, P = 0.0004), there were no significant differences between the PFBN group and the control group in terms of postoperative hip range of motion, femoral neck‒shaft angle, intraoperative fluoroscopy time, or incision length (flexion and extension: SMD = 0.28, 95% CI -0.18 ~ 0.73, P = 0.23; rotation: SMD = 0.20, 95% CI -0.25 ~ 0.66, P = 0.38; femoral neck‒shaft angle: SMD = 0.32, 95% CI -0.23 ~ 0.87, P = 0.25; intraoperative fluoroscopy time: SMD = 0.84, 95% CI -0.24 ~ 1.92, P = 0.13; incision length: SMD = 0.23, 95% CI -0.44 ~ 0.89, P = 0.50). As shown in Table 2 . 2.5 Sensitivity analysis In this study, sensitivity analysis was carried out on the above studies with high heterogeneity via leave-one-out and change effect models. The results revealed that all the results were stable and reliable with no significant changes, and no source of heterogeneity was found. The analysis results of the random effects model were acceptable. 2.6 Publication bias The operation duration was used as an example to assess publication bias. The funnel plot, which displays a symmetrical funnel shape, indicates that the risk of publication bias in the included studies was not significant. As shown in Fig. 12 . Discussion 3.1 Findings of this study This study conducted a systematic review and meta-analysis of the clinical efficacy and safety of PFBN compared with PFNA or InterTAN. Compared with previous related research findings, the following characteristics are presented: In terms of clinical efficacy, this study indicates that PFBN may have certain advantages in some aspects. Compared with PFNA and InterTAN, PFBN demonstrates superior performance in maintaining the stability of fracture reduction and reducing the time required for fracture healing. It allows for earlier ambulation postoperatively without increasing the risk of internal fixation failure [ 33 – 34 ] . This not only aids in patients’ quicker recovery of physical functions and enhances their independence and autonomy in daily life but also has a positive and profound impact on the overall rehabilitation process. These benefits include the prevention of complications and a reduction in mortality rates [ 33 ] . This may be attributed to its unique biomimetic design, which better conforms to the anatomical structure of the proximal femur, restores the physiological fulcrum position of the proximal femur, provides a more appropriate stress distribution, and offers more sustained and robust fixation [ 17 , 36 ] . PFNA and InterTAN may not provide ideal fixation for the lateral wall of the IFF, and the spiral blade of its anti-rotating screw is not supported effectively, which may result in a significant increase in cutting stress. This can result in displacement of the femoral head, followed by the four major challenges of "retrograde nail, rotation, cutting, and instability." Subsequently, complications such as failure of internal fixation and varus collapse of the hip may arise [ 37 – 40 ] . Since these shortcomings were identified, efforts have been continuously made to explore solutions [ 17 , 35 , 41 – 42 ] . In terms of safety, the amount of intraoperative blood loss in PFBN is relatively lower than that in PFNA, while there is no significant difference compared with that in InterTAN. The incidence of postoperative complications also exhibited the same characteristics (see Table 2 and Fig. 11 ). Some studies have also indicated that PFBN has a lower mortality rate than hip replacement does [ 43 ] , suggesting that PFBN may have a potential advantage in reducing surgical risk. However, there is also complexity and specificity between different treatment methods, a characteristic that warrants in-depth analysis. PFBN may enhance internal fixation stability and reduce the risk of complications through its more optimized structural design. By triangulating the tension screws and pressure screws, the fractures of the main pressure bone trabeculae are repaired, the shear forces on the main tension bone trabeculae are reduced [ 12 – 13 ] , and the center of the force arm is closer to the physiological fulcrum [ 27 ] . This design aligns the forces more closely with the body's natural mechanics, which can improve the stability of internal fixation and reduce the risk of complications such as loosening or failure of internal fixation [ 44 ] . This not only reduces the intraoperative risk but also may have a positive impact on patients’ early postoperative recovery and reduce the incidence of complications. For example, it can lead to a decrease in anemia-related complications, accelerate postoperative weight bearing, reduce postoperative pain, and mitigate inflammatory responses. Compared with PFNA and InterTAN, PFBN did not significantly differ in terms of surgical duration, incision length, intraoperative fluoroscopy time, or postoperative hip range of motion (Table 2 ). These findings suggest that PFBN does not have a clear advantage over PFNA or InterTAN in terms of certain surgical and postoperative recovery indicators and that the overall efficacy of the three internal fixation methods is essentially comparable. As seen from the forest plot, the operative times of PFNA and InterTAN were numerically shorter than that of PFBN, although the difference was not statistically significant. The reason might be that the insertion of transverse support screws has, to some extent, increased the surgical time [ 22 – 24 ] . Additionally, the surgical duration and length of hospital stay may also vary due to the interactive effects of various other factors, such as the surgeon's experience and technical skill, the patient's physical condition, and postoperative care and rehabilitation management. These factors can significantly influence patient outcomes and should be taken into account when evaluating the overall surgical process and recovery. The length of the surgical incision is likely to be primarily determined by the choice of surgical approach rather than the internal fixation device itself. The number of intraoperative fluoroscopies is likely more closely related to the complexity of the surgery and the surgeon's experience rather than being solely dependent on the type of internal fixation used. Postoperative hip range of motion is more closely associated with factors such as postoperative rehabilitation exercises. In summary, PFBN has advantages in terms of early postoperative weight bearing time, fracture healing time, postoperative complication rates, length of hospital stay, and intraoperative blood loss. However, in other aspects, the differences between PFBN and PFNA or InterTAN are not significant. This provides an important reference for the selection of clinical treatment plans. On the basis of the patient's specific conditions and the surgeon's experience, the unique advantages of PFBN can be weighed against the relative consistency in other aspects to formulate the most appropriate surgical strategy. 3.2 Limitations and strengths 3.2.1 Strengths of this study: At present, only a small number of efficacy observational studies have been published, with conclusions that are not entirely consistent. There is a notable absence of comprehensive meta-analyses that synthesize the findings from these studies. On the basis of existing clinical studies, this study aims to evaluate the advantages and disadvantages of the efficacy and safety of PFBN compared with PFNA and InterTAN in the treatment of IFF through meta-analysis, providing a valuable reference for the clinical treatment of IFF. This represents the strengths and novel aspects of this study. 3.2.2 Limitations of this study: First, all the studies included in this paper were cohort studies, which are considered to have a lower level of evidence than randomized controlled trials (RCTs). Second, some studies have relatively short follow-up periods (less than 1 year), which lack long-term assessment and may have a certain impact on the evaluation of outcomes. Third, the sample sizes of the included studies were generally small, and large-sample RCTs to corroborate the findings are lacking. Fourth, owing to the variability in the proficiency of the surgical staff, there may be differences in the assessment of intraoperative indicators such as surgical time and intraoperative blood loss. This study has standardized all the assessment criteria to minimize such impacts. These factors may all potentially influence the level of evidence of the outcomes. In the future, it will be necessary to conduct more rigorously designed, large-sample, multicenter, high-quality RCTs to further validate the clinical efficacy of PFBN. Conclusion In conclusion, PFBN, PFNA, and InterTAN all yield satisfactory therapeutic outcomes in the treatment of intertrochanteric femoral fractures. Moreover, there were no significant differences between PFBN and the other two treatment modalities in terms of surgical duration, postoperative Harris score, intraoperative blood loss, incision length, or hip range of motion. However, PFBN has advantages over control treatments in terms of postoperative weight-bearing time, fracture healing time, quality of fracture reduction, postoperative complication rates, hospital stay, and postoperative VAS score. Therefore, in the future, on the basis of the situation of patients and the experience of surgeons, we can weigh the unique advantages of PFBN and the relative consistency of other aspects to develop the most appropriate surgical strategy to achieve earlier fracture healing and early weight bearing and reduce the occurrence of complications. Nevertheless, the conclusions of this study still require further validation through more rigorously designed, large-sample, multicenter, high-quality RCTs to achieve more reliable results. Abbreviations PFBN: Proximal femur bionic nail; PFNA: Proximal femoral nail anti-rotation; IFF: Intertrochanteric femoral fracture; CNKI: China National Knowledge Infrastructure; RevMan 5.4: Review Manager 5.4; VAS: Visual analog scale; SMD: Standardized mean difference; CI: Confidence interval; RR: Relative risk; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; NOS: Newcastle-Ottawa Quality Assessment Scale; RCTs: Randomized controlled trials. Declarations Author contributions statement Conceptualization: WB-Z and YL-M. Search: WB-Z and FL-L. Data extraction and quality assessment: YL-M and WB-Z. Statistical analysis: YL-M and H-S. Writing: WB-Z, FL-L and YL-M. Supervision and modifications: YM-H. Revising the manuscript: WB-Z, FL-L, ZX-Y and XM-D. YL-M, WB-Z, FL-L contributed equally to the study. All authors reviewed the manuscript. Funding This research was funded by the National Natural Science Foundation of China (project number 325021015), the Sichuan Provincial Administration of Traditional Chinese Medicine (project number 2021MS454), the Special Fund for 100 Talents Program of the Affiliated Hospital of Chengdu University of TCM (project number 22-B07), and the Scientific Research Promotion Plan of Xinglin Scholars Discipline Talents of Chengdu University of TCM (project number 030058047). Conflicts of interest statement The authors have no conflicts of interest to disclose. Ethics approval and consent to participate Not applicable. This is a data analysis and systematic review of published studies, which does not involve ethical review and does not require the signing of informed consent. Informed consent of participants should be conducted in the original study included in the analysis. Consent for publication Not applicable. Clinical trial number Not applicable Data availability All the data generated or analyzed during this study are included in this published article, where specific analytical details and original literature are reasonably available by contacting the first author (Yulin Ma) if necessary. Contributor Information Yulin Ma , Email: [email protected] . Wenbin Zhang , Email: [email protected] . Feilong Lu , Email: [email protected] . Hao Song , Email: [email protected] . Xiaoming Du, Email: [email protected] Zhaoxi Yang, Email: [email protected] Yimei Hu , Email: [email protected] . References Chang SM, Hou ZY, Hu SJ, et al. Intertrochanteric Femur Fracture Treatment in Asia: What We Know and What the World Can Learn. Orthop Clin North Am . 2020; 51(2): 189-205. DOI:10.1016/j.ocl.2019.11.011. Veronese N, Maggi S. Epidemiology and social costs of hip fracture. Injury . 2018; 49(8): 1458-1460. DOI:10.1016/j.injury.2018.04.015. Wang T, Guo J, Long Y, et al. 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Progress in the study of risk factors for internal fixation failure after intertrochanteric fracture. Chin J Orthop Trauma , 2021, 23(3): 233-238. DOI:10.3760/cma.j.cn115530-20200909-00585. Zhang XM, Yu K, Wang YH, et al. Analysis of characteristics and causes of postoperative invalid fixation failures of femoral intertrochanteric fractures. Chin J Trauma , 2021, 37(5): 429-436. DOI:10.3760/cma.j.cn501098-20200901-00573. Shi Z, Qiang M, Jia X, et al. Association of the lateral wall integrity with clinical outcomes in older patients with intertrochanteric hip fractures treated with the proximal femoral nail anti-rotation-Asia. Int Orthop . 2021; 45(12): 3233-3242. DOI:10.1007/s00264-021-05211-1. Chen ZX, Hu CY, Zhen ZH, et al. Effectiveness of proximal femoral nail anti-rotation combined with minimally invasive percutaneous plate osteosynthesis versus Intertan intramedullary nail fixation in treatment of intertrochanteric fracture with incomplete lateral wall. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5336804","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":510911977,"identity":"cd67a30e-e5ab-41c7-ac91-eea0e90dc3c6","order_by":0,"name":"Yulin Ma","email":"","orcid":"","institution":"Chengdu University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yulin","middleName":"","lastName":"Ma","suffix":""},{"id":510911978,"identity":"4c059b7c-b5a0-43c9-8539-646ff9e888bb","order_by":1,"name":"Wenbin 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score.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-5336804/v1/894a021c0bcbd0a3acac8416.png"},{"id":90897330,"identity":"430b755b-bd9c-4e18-892b-ade1b0abb30e","added_by":"auto","created_at":"2025-09-09 11:40:55","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":202334,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMeta-analysis results of the postoperative VAS score.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"7.png","url":"https://assets-eu.researchsquare.com/files/rs-5336804/v1/b769c8ef65c2cba083af7a56.png"},{"id":90895407,"identity":"c780396e-9925-4928-af3a-67791ad27f3a","added_by":"auto","created_at":"2025-09-09 11:32:55","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":267059,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMeta-analysis results of the postoperative complication rate.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"8.png","url":"https://assets-eu.researchsquare.com/files/rs-5336804/v1/ced18ed094d6ff255510f4c2.png"},{"id":90895410,"identity":"87c29643-a583-4681-9eb9-600152c988d5","added_by":"auto","created_at":"2025-09-09 11:32:55","extension":"png","order_by":9,"title":"Figure 9","display":"","copyAsset":false,"role":"figure","size":262349,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMeta-analysis results for the length of hospital stay.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"9.png","url":"https://assets-eu.researchsquare.com/files/rs-5336804/v1/49c70e8167d5f5e5daa886f8.png"},{"id":90897333,"identity":"7de3a8c7-c011-42af-9a9b-3baae95beba0","added_by":"auto","created_at":"2025-09-09 11:40:55","extension":"png","order_by":10,"title":"Figure 10","display":"","copyAsset":false,"role":"figure","size":322069,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMeta-analysis results of intraoperative blood loss.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"10.png","url":"https://assets-eu.researchsquare.com/files/rs-5336804/v1/bfbbe73fd36c3c5bcbb1813c.png"},{"id":90895409,"identity":"2c73bc4c-5f44-499b-8f2f-3d73f8e8797d","added_by":"auto","created_at":"2025-09-09 11:32:55","extension":"png","order_by":11,"title":"Figure 11","display":"","copyAsset":false,"role":"figure","size":347772,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMeta-analysis results of operation duration.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"11.png","url":"https://assets-eu.researchsquare.com/files/rs-5336804/v1/bf6523057fcd674cb78d53af.png"},{"id":90895404,"identity":"ecf28f43-e13d-40dc-a6bd-a67965c63746","added_by":"auto","created_at":"2025-09-09 11:32:55","extension":"png","order_by":12,"title":"Figure 12","display":"","copyAsset":false,"role":"figure","size":44791,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFunnel plot of the operation time.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"12.png","url":"https://assets-eu.researchsquare.com/files/rs-5336804/v1/a04826f2629c9ba175dfbf75.png"},{"id":90897750,"identity":"0d9fa44e-bde2-4d71-a4bf-bc3f8e38a4cc","added_by":"auto","created_at":"2025-09-09 11:48:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4298262,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5336804/v1/cfb6d2e7-007f-4279-8402-a721106a3bf8.pdf"},{"id":90895405,"identity":"09c2c232-970a-407a-b341-a5a33a466ad5","added_by":"auto","created_at":"2025-09-09 11:32:55","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":284057,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryAppendix1.Searchstrategy.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5336804/v1/8e9a028c9acad94baac1cd47.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical effects and safety of proximal femur bionic nail versus proximal femoral nail anti-rotation and InterTAN for the treatment of intertrochanteric femoral fracture: a systematic review and meta-analysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIntertrochanteric femoral fracture (IFF) is among the most prevalent types of hip fractures. Projections suggest that by 2050, the global incidence of hip fractures will increase to 4.5-6 million annually, with IFF accounting for more than 50% of these cases\u003csup\u003e[1-\u003c/sup\u003e\u003csup\u003e2]\u003c/sup\u003e. This condition tends to occur in elderly individuals and is characterized by a high rate of complications and mortality. Research indicates that the 6-month mortality rate for IFF in elderly patients is 7.6%, increasing to 13.9% within the first year and potentially reaching as high as 28.5% within 2 years\u003csup\u003e[3]\u003c/sup\u003e. Therefore, this disease is also known as the \u0026quot;last fracture of life\u0026quot;. With increasing age, its incidence increases annually\u003csup\u003e[4]\u003c/sup\u003e. Currently, the primary treatment approaches for IFF are categorized into intramedullary and extramedullary fixation. Intramedullary fixation is often preferred by clinicians because of its ability to minimize tissue disruption and high mechanical stability. The primary methods for intramedullary fixation, including proximal femoral nail anti-rotation (PFNA), the Gamma nail, and InterTAN, are not without flaws, particularly concerning the quality of fracture reduction and the rate of postoperative complications\u003csup\u003e[5-\u003c/sup\u003e\u003csup\u003e6]\u003c/sup\u003e. These concerns are especially pertinent in the context of unstable fractures, such as the reverse intertrochanteric type\u003csup\u003e[7-\u003c/sup\u003e\u003csup\u003e9]\u003c/sup\u003e. In view of these aspects, in recent years, many theories, such as \u0026quot;lever-balance-reconstruction\u0026quot; theory\u003csup\u003e[10-\u003c/sup\u003e\u003csup\u003e11]\u003c/sup\u003e, \u0026quot;triangular support fixation\u0026quot; theory\u003csup\u003e[12]\u003c/sup\u003e, \u0026quot;Zhang\u0026apos;s N-triangle\u0026quot; theory\u003csup\u003e[13]\u003c/sup\u003e, and \u0026quot;triangular mechanical reconstruction of the proximal femur\u0026quot;\u003csup\u003e[14]\u003c/sup\u003e, have been proposed to solve the current dilemma. In accordance with these theories, Professor Zhang Dianying\u0026apos;s team proposed the proximal femur bionic nail (PFBN) system. On the basis of these theories, PFBN adds a transverse interlocking support screw to the proximal end of the main nail, and the transverse screw, main nail and the anti-rotation screw form a stable triangular cross structure in the proximal femur, which significantly increases the stability and fixation strength of the proximal femur fracture. This design plays an anti-rotation role, lowers complication rates, and promotes fracture healing and early weight-bearing activity\u003csup\u003e[16-\u003c/sup\u003e\u003csup\u003e17]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eAs a treatment strategy for IFF, PFBN is gaining attention for its ability to improve fracture reduction quality, promote healing, and enable early postoperative mobilization. Some clinical studies\u003csup\u003e[18\u003c/sup\u003e\u003csup\u003e-19]\u003c/sup\u003e highlight the potential clinical advantages of PFBN in promoting IFF healing and early activity without increasing the incidence of complications or surgical risks; however, this perspective lacks a comprehensive evaluation. Consequently, this study is the first comprehensive analysis of the clinical efficacy and safety of PFBN compared with PFNA and InterTAN in the treatment of IFF, aiming to provide evidence-based medical support for the clinical application of PFBN in IFF treatment.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eThe study was conducted according to our preregistered protocol on PROSPERO and the guidance of the PRISMA statement\u003csup\u003e[20]\u003c/sup\u003e. The PROSPERO registration number for this study is \u003cstrong\u003eCRD42024549360\u003c/strong\u003e.\u003c/p\u003e\n\u003ch3\u003e1.1 Inclusion and exclusion criteria\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003e1.1.1 Inclusion criteria\u003c/strong\u003e: (1) Study type: clinical controlled study; (2) Study population: patients diagnosed with IFF requiring surgical treatment; (3) Interventions: the intervention group was treated with PFBN, whereas the control group was treated with PFNA or InterTAN; (4) Outcome: included at least one or more of the following: partial weight bearing time, full weight bearing time, fracture healing time, fracture reduction quality, Harris scale, hospital stay, operation duration, intraoperative blood loss, postoperative complication rate, femoral neck\u0026ndash;shaft angle, tip\u0026ndash;apex distance, hip range of motion, VAS scale, etc.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.1.2 Exclusion criteria\u003c/strong\u003e: (1) studies with incomplete data for analysis; (2) full texts not available; and (3) duplicate studies.\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003ch2\u003e1.2 Search strategy\u003c/h2\u003e\n\u003cp\u003eA search was conducted in databases including PubMed, WOS, Embase, Cochrane, CNKI, Wanfang, and VIP for clinically controlled studies on the treatment of intertrochanteric femoral fracture (IFF) with PFBN published prior to August 2024. \u0026quot;Proximal femur bionic nail\u0026quot; and \u0026quot;PFBN\u0026quot; were used as search terms. The search strategy is shown in \u003cstrong\u003eSupplementary Appendix 1.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003e1.3 Literature screening and data extraction\u003c/h2\u003e\n \u003cp\u003eAfter the studies were retrieved, they were imported into EndNote, and duplicate references were removed. Two researchers (Zhang and Ma) independently screened the literature on the basis of the inclusion and exclusion criteria. The titles and abstracts of the remaining studies were read after removing duplicates and preliminarily excluding irrelevant studies, after which the full texts of the remaining studies were read. Finally, data from the literature, including basic features of the literature (author names, country, publication year, etc.) and the patients (intervention and control measures, sample size, sex ratio, age, follow-up time, etc.), trial results, and quality assessment methods, were extracted. In the case of any disagreements, a third researcher assessed and made the final decision. After the extraction was complete, the data were entered into RevMan 5.4 software for analysis.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003e1.4 Quality evaluation of the literature\u003c/h2\u003e\n \u003cp\u003eThe quality of cohort studies was assessed according to the Newcastle‒Ottawa Quality Assessment Scale (NOS)\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. A funnel plot was used to assess the presence of publication bias in the included studies.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003e1.5 Statistical methods\u003c/h2\u003e\n \u003cp\u003eData analysis was performed via Review Manager 5.4 (RevMan 5.4) software. Binary variables are expressed as the relative risk (\u003cem\u003eRR\u003c/em\u003e) and 95% confidence interval (\u003cem\u003eCI\u003c/em\u003e), whereas continuous variables are expressed as the standardized mean difference (\u003cem\u003eSMD\u003c/em\u003e) and 95% CI. For heterogeneity testing, the chi-square test and \u003cem\u003eI\u0026sup2;\u003c/em\u003e test were used. When \u003cem\u003eI\u0026sup2;\u003c/em\u003e \u0026le; 50% and \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026ge;\u0026thinsp;0.1, low heterogeneity was indicated, and a fixed effects model was selected. Conversely, if \u003cem\u003eI\u0026sup2;\u003c/em\u003e \u0026gt;50% or \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.1, high heterogeneity was suggested. If the source of heterogeneity could not be identified, a random effects model was chosen for analysis, and sensitivity analysis was conducted when necessary. A difference was considered statistically significant when \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Literature search results\u003c/h2\u003e\u003cp\u003eIn the initial assessment, 137 studies were identified. Following a rigorous preliminary review, the full-text examination led to the retention of 13 studies that met the inclusion criteria of this research\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan additionalcitationids=\"CR23 CR24 CR25 CR26 CR27 CR28 CR29 CR30 CR31\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e. Notably, all 13 retained studies had a cohort design. The literature screening process is depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eA total of 13 studies with 825 patients were included, of which 339 were treated with PFBN, 393 with PFNA, and 93 with InterTAN. The essential characteristics of the studies included in this study are provided in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003eBasic characteristics of the included studies\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAuthor(Year)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSample Size (F/M)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean age (years old)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eOutcome\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNOS\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFu HP(2023)\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePFBN\u003c/p\u003e\u003cp\u003ePFNA\u003c/p\u003e\u003cp\u003eInterTAN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18(10/8)\u003c/p\u003e\u003cp\u003e36(24/12)\u003c/p\u003e\u003cp\u003e14(9/5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e76.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8\u003c/p\u003e\u003cp\u003e79.7\u0026thinsp;\u0026plusmn;\u0026thinsp;7.8\u003c/p\u003e\u003cp\u003e81.4\u0026thinsp;\u0026plusmn;\u0026thinsp;7.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(1)(3)(5)(10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJin LK(2024)\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePFBN\u003c/p\u003e\u003cp\u003ePFNA\u003c/p\u003e\u003cp\u003eInterTAN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25(16/9)\u003c/p\u003e\u003cp\u003e55(38/17)\u003c/p\u003e\u003cp\u003e40(26/14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e73.67\u0026thinsp;\u0026plusmn;\u0026thinsp;5.16\u003c/p\u003e\u003cp\u003e74.23\u0026thinsp;\u0026plusmn;\u0026thinsp;5.57\u003c/p\u003e\u003cp\u003e73.45\u0026thinsp;\u0026plusmn;\u0026thinsp;5.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(1)(3)(5)(7)(8)(9)(10)(15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLiu PY(2023)\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePFBN\u003c/p\u003e\u003cp\u003ePFNA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35(15/20)\u003c/p\u003e\u003cp\u003e37(15/22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e71.81\u0026thinsp;\u0026plusmn;\u0026thinsp;7.63\u003c/p\u003e\u003cp\u003e72.33\u0026thinsp;\u0026plusmn;\u0026thinsp;6.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(1)(2)(3)(4)(5)(7)(8)(9)(10)(14)(15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLong ZM(2022)\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePFBN\u003c/p\u003e\u003cp\u003ePFNA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20(9/11)\u003c/p\u003e\u003cp\u003e60(21/39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e63.57\u0026thinsp;\u0026plusmn;\u0026thinsp;6.84\u003c/p\u003e\u003cp\u003e63.29\u0026thinsp;\u0026plusmn;\u0026thinsp;5.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(1)(3)(4)(5)(7)(8)(9)(10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLin F (2023)\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePFBN\u003c/p\u003e\u003cp\u003ePFNA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28(16/12)\u003c/p\u003e\u003cp\u003e28(18/10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e70.4\u0026thinsp;\u0026plusmn;\u0026thinsp;7.8\u003c/p\u003e\u003cp\u003e73.0\u0026thinsp;\u0026plusmn;\u0026thinsp;8.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(3)(4)(5)(7)(9)(10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLi ZT (2022)\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePFBN\u003c/p\u003e\u003cp\u003ePFNA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46(24/22)\u003c/p\u003e\u003cp\u003e46(26/20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e75.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.2\u003c/p\u003e\u003cp\u003e75.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(1)(4)(5)(7)(8)(9)(10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLin D (2022)\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePFBN\u003c/p\u003e\u003cp\u003ePFNA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20(14/6)\u003c/p\u003e\u003cp\u003e25(18/7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e78.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.9\u003c/p\u003e\u003cp\u003e78.7\u0026thinsp;\u0026plusmn;\u0026thinsp;8.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(2)(3)(5)(7)(9)(10)(12)(13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eZhang RB (2022)\u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePFBN\u003c/p\u003e\u003cp\u003ePFNA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32(13/19)\u003c/p\u003e\u003cp\u003e32(12/20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e79.24\u0026thinsp;\u0026plusmn;\u0026thinsp;1.23\u003c/p\u003e\u003cp\u003e79.17\u0026thinsp;\u0026plusmn;\u0026thinsp;1.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(1)(8)(9)(10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYang DS (2023)\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePFBN\u003c/p\u003e\u003cp\u003ePFNA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24(13/11)\u003c/p\u003e\u003cp\u003e24(15/9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e79.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0\u003c/p\u003e\u003cp\u003e78.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(1)(3)(4)(6)(7)(8)(9)(10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWang YC (2023)\u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePFBN\u003c/p\u003e\u003cp\u003ePFNA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20(11/9)\u003c/p\u003e\u003cp\u003e20(12/8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e75.3\u0026thinsp;\u0026plusmn;\u0026thinsp;6.4\u003c/p\u003e\u003cp\u003e74.6\u0026thinsp;\u0026plusmn;\u0026thinsp;6.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(1)(2)(5)(6)(8)(9)(10)(11)(12)(15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWu YX (2023)\u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePFBN\u003c/p\u003e\u003cp\u003ePFNA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30(13/17)\u003c/p\u003e\u003cp\u003e30(12/18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e69.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003c/p\u003e\u003cp\u003e69.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(3)(5)(7)(9)(10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWan Y (2024)\u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePFBN\u003c/p\u003e\u003cp\u003eInterTAN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16(11/5)\u003c/p\u003e\u003cp\u003e19(15/4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e78.0\u0026thinsp;\u0026plusmn;\u0026thinsp;8.8\u003c/p\u003e\u003cp\u003e75.3\u0026thinsp;\u0026plusmn;\u0026thinsp;7.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(1)(2)(5)(6)(8)(9)(10)(11)(13)(14)(15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJia C (2024)\u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePFBN\u003c/p\u003e\u003cp\u003eInterTAN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25(17/8)\u003c/p\u003e\u003cp\u003e20(13/7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e83.28\u0026thinsp;\u0026plusmn;\u0026thinsp;7.85\u003c/p\u003e\u003cp\u003e79.90\u0026thinsp;\u0026plusmn;\u0026thinsp;9.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(1)(2)(3)(4)(5)(7)(8)(9)(10)(14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003eNote\u003c/b\u003e: (1) Partial weight bearing time; (2) Full weight bearing time; (3) Fracture healing time; (4) Fracture reduction quality; (5) Harris scale; (6) VAS; (7) Postoperative complication rate; (8) Hospital stay; (9) Intraoperative blood loss; (10) Operation duration; (11) Hip range of motion; (12) Femoral neck-shaft angle; (13) Tip-apex distance; (14) Intraoperative fluoroscopy times; (15) Incision length.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Quality assessment results\u003c/h2\u003e\u003cp\u003eAmong the included cohort studies, exposure determination and cohort selection were distinct and comparable, with no pre-existing outcomes. The outcome index measurement method was suitable. Seven studies\u003csup\u003e[18\u0026ndash;19,24\u0026minus;26,29\u0026ndash;30]\u003c/sup\u003e reported follow-up periods of less than one year. One study\u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e did not detail the follow-up times or procedures and thus was not scored. All studies scored over 7 on the NOS scale, ensuring quality.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Meta-analysis results\u003c/h2\u003e\u003cp\u003eA summary of the meta-analysis results is shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSummary of the meta-analysis results of the included studies\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eOutcome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSubgroup\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eHeterogeneity test\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eEffect models\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003eMeta-analysis results\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eI\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eSMD/RR\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003e95%CI\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ePartial weight bearing time \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePFNA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.00001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-3.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[-4.46, -2.26]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.00001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInterTAN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.00001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-2.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[-4.39, -0.09]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.00001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-3.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[-4.02, -2.09]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.00001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eFull weight bearing time \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePFNA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e91%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-1.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[-2.88, -0.33]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInterTAN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e/\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e/\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-2.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[-3.23, -1.46]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.00001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e89%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.00001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-1.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[-2.86, -0.70]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eFracture healing time \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePFNA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e74%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.0002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[-0.84 -0.16]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInterTAN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[-1.06, -0.37]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.0007\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[-0.82, -0.28]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eFracture reduction quality \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePFNA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[1.01, 1.16]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInterTAN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[0.89, 1.15]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.87*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[1.01, 1.13]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eHarris scale \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePFNA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e72%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[0.01, 0.83]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInterTAN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[-0.38, 0.59]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.68*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e67%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[0.00, 0.64]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.05*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eVAS scale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePFNA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[-1.13, -0.26]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInterTAN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e/\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e/\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[-0.84, 0.49]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.60*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[-0.90, -0.18]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ePostoperative complication rate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePFNA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[0.17, 0.58]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.0002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInterTAN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[0.21, 1.60]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.30*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[0.21, 0.61]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.0001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eHospital stay\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePFNA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e59%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[-0.35, 0.03]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.09*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInterTAN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[-0.50, 0.16]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.31*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[-0.33, 0.00]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eIntraoperative blood loss \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePFNA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e94%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.00001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[-1.53, -0.03]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInterTAN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[-0.57, 0.64]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.90*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e93%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.00001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[-1.16, 0.02]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.06*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eOperation duration \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePFNA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e93%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.00001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[-0.37, 0.85]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.44*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInterTAN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e80%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[-0.34, 1.08]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.31*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e91%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.00001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[-0.20, 0.76]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.26*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eHip range of motion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFlexion and extension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[-0.18, 0.73]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.23*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRotation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[-0.25, 0.66]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.38*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eFemoral neck-shaft angle \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePFNA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e78%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[-0.93, 0.92]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.99*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInterTAN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[0.20, 1.10]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e67%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[-0.23, 0.87]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.25*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eTip-apex distance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePFNA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e/\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e/\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[-1.08, 0.11]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.11*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInterTAN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e/\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e/\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[-1.61, -0.20]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[-1.12, -0.21]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eIntraoperative fluoroscopy times \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePFNA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e94%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[-1.00, 2.63]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.38*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInterTAN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e94%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[-1.23, 3.02]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.41*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e91%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.00001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[-0.24, 1.92]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.13*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eIncision length \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePFNA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e89%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.0001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[-0.67, 1.19]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.59*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInterTAN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e91%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[-1.23, 1.65]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.78*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOverall\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e86%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.00001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e[-0.44, 0.89]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.50*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003cb\u003eNote\u003c/b\u003e: \u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e: The results of the sensitivity analysis were stable, and the results of the random effects analysis were acceptable; \u003cb\u003e*\u003c/b\u003e: No significant difference between the two groups. \u003cb\u003eR\u003c/b\u003e: Random effects model; \u003cb\u003eF\u003c/b\u003e: Fixed effects model.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec10\" class=\"Section3\"\u003e\u003ch2\u003e2.3.1 Partial weight bearing time\u003c/h2\u003e\u003cp\u003eA total of 9 studies\u003csup\u003e[18\u0026ndash;19,22\u0026minus;24,26,28\u0026ndash;29,31]\u003c/sup\u003e reported partial weight-bearing time after surgery. The results revealed that the partial weight-bearing time in the PFBN group was significantly shorter than that in the control group (PFNA: \u003cem\u003eSMD\u003c/em\u003e = -3.36, \u003cem\u003e95% CI\u003c/em\u003e -4.46~-2.26, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.00001; InterTAN: \u003cem\u003eSMD\u003c/em\u003e = -2.24, \u003cem\u003e95% CI\u003c/em\u003e -4.39~-0.09, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.04; Overall: \u003cem\u003eSMD\u003c/em\u003e = -3.06, \u003cem\u003e95% CI\u003c/em\u003e -4.02~-2.09, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.00001). As shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section3\"\u003e\u003ch2\u003e2.3.2 Full weight bearing time\u003c/h2\u003e\u003cp\u003eFour studies\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e reported the full weight-bearing time after surgery, with the PFBN group showing a significantly shorter duration than the control group did (PFNA: \u003cem\u003eSMD\u003c/em\u003e = -1.61, \u003cem\u003e95% CI\u003c/em\u003e -2.88~-0.33, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.01; InterTAN: \u003cem\u003eSMD\u003c/em\u003e = -2.34, \u003cem\u003e95% CI\u003c/em\u003e -3.23~-1.46, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.00001; Overall: \u003cem\u003eSMD\u003c/em\u003e = -1.78, \u003cem\u003e95% CI\u003c/em\u003e -2.86~-0.70, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001). As shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section3\"\u003e\u003ch2\u003e2.3.3 Fracture healing time\u003c/h2\u003e\u003cp\u003eA total of 10 studies\u003csup\u003e[18\u0026ndash;19,22\u0026minus;27,30,32]\u003c/sup\u003e reported fracture healing times. The results revealed that the fracture healing time in the PFBN group was significantly shorter than that in the control group (PFNA: \u003cem\u003eSMD\u003c/em\u003e = -0.50 \u003cem\u003e95% CI\u003c/em\u003e -0.84~-0.16, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004; InterTAN: \u003cem\u003eSMD\u003c/em\u003e = -0.72, \u003cem\u003e95% CI\u003c/em\u003e -1.06~-0.37, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001; Overall: \u003cem\u003eSMD\u003c/em\u003e = -0.55, \u003cem\u003e95% CI\u003c/em\u003e -0.82~-0.28, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). As shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section3\"\u003e\u003ch2\u003e2.3.4 Fracture reduction quality\u003c/h2\u003e\u003cp\u003eEight studies\u003csup\u003e[18,24\u0026ndash;26,29\u0026minus;32]\u003c/sup\u003e reported the fracture reduction quality, that is, the rates of good and excellent reduction quality. The results revealed that the quality of fracture reduction in the PFBN group was greater than that in the control group, and the difference was statistically significant (PFNA: \u003cem\u003eRR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.08, \u003cem\u003e95% CI\u003c/em\u003e 1.01\u0026thinsp;~\u0026thinsp;1.16, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.02; InterTAN: \u003cem\u003eRR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.01, \u003cem\u003e95% CI\u003c/em\u003e 0.89\u0026thinsp;~\u0026thinsp;1.15, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.87; Overall: \u003cem\u003eRR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.07, \u003cem\u003e95% CI\u003c/em\u003e 1.01\u0026thinsp;~\u0026thinsp;1.13, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.02). As shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section3\"\u003e\u003ch2\u003e2.3.5 Postoperative hip Harris score\u003c/h2\u003e\u003cp\u003eEight studies\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan additionalcitationids=\"CR30 CR31\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e reported postoperative hip Harris scores, although the score in the control group was lower than that in the PFBN group was, the difference was not statistically significant (PFNA: \u003cem\u003eSMD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.42, \u003cem\u003e95% CI\u003c/em\u003e 0.01\u0026thinsp;~\u0026thinsp;0.83, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.05; InterTAN: \u003cem\u003eSMD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.10, \u003cem\u003e95% CI\u003c/em\u003e -0.38\u0026thinsp;~\u0026thinsp;0.59, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.68; Overall: \u003cem\u003eSMD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.32, \u003cem\u003e95% CI\u003c/em\u003e 0.00\u0026thinsp;~\u0026thinsp;0.64, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.05). As shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section3\"\u003e\u003ch2\u003e2.3.6 Postoperative VAS score\u003c/h2\u003e\u003cp\u003eA total of 3 studies\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e reported postoperative VAS scores. The results revealed that the postoperative VAS score in the PFBN group was significantly lower than that in the control group (PFNA: \u003cem\u003eSMD\u003c/em\u003e = -0.69, \u003cem\u003e95% CI\u003c/em\u003e -1.13~-0.26, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002; InterTAN: \u003cem\u003eSMD\u003c/em\u003e = -0.18, \u003cem\u003e95% CI\u003c/em\u003e -0.84\u0026thinsp;~\u0026thinsp;0.49, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.60; Overall: \u003cem\u003eSMD\u003c/em\u003e = -0.54, \u003cem\u003e95% CI\u003c/em\u003e -0.90~-0.18, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003). As shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section3\"\u003e\u003ch2\u003e2.3.7 Postoperative complication rate (safety assessment)\u003c/h2\u003e\u003cp\u003eA total of 7 studies\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e reported postoperative complication rates, known as safety assessments. The results revealed that the postoperative complication rate in the PFBN group was significantly lower than that in the control group (PFNA: \u003cem\u003eRR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.31, \u003cem\u003e95% CI\u003c/em\u003e 0.17\u0026thinsp;~\u0026thinsp;0.58, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0002; InterTAN: \u003cem\u003eRR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.58, \u003cem\u003e95% CI\u003c/em\u003e 0.21\u0026thinsp;~\u0026thinsp;1.60, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.30; Overall: \u003cem\u003eRR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.36, \u003cem\u003e95% CI\u003c/em\u003e 0.21\u0026thinsp;~\u0026thinsp;0.61, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0001). Thus, to a certain extent, patients with IFF are relatively safer in choosing PFBN treatment. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section3\"\u003e\u003ch2\u003e2.3.8 Hospital stay\u003c/h2\u003e\u003cp\u003eNine studies\u003csup\u003e[18\u0026ndash;19,23\u0026minus;24,26,28\u0026ndash;29,31\u0026minus;32]\u003c/sup\u003e reported the duration of hospital stay. The results indicated that while the PFBN group had shorter hospital stays than did the control group did, the difference was statistically significant (PFNA: \u003cem\u003eSMD\u003c/em\u003e = -0.16, \u003cem\u003e95% CI\u003c/em\u003e -0.35\u0026thinsp;~\u0026thinsp;0.03, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.09; InterTAN: \u003cem\u003eSMD\u003c/em\u003e = -0.17, \u003cem\u003e95% CI\u003c/em\u003e -0.50\u0026thinsp;~\u0026thinsp;0.16, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.31; Overall: \u003cem\u003eSMD\u003c/em\u003e = -0.16, \u003cem\u003e95% CI\u003c/em\u003e -0.33\u0026thinsp;~\u0026thinsp;0.00, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.05). As shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig9\" class=\"InternalRef\"\u003e9\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section3\"\u003e\u003ch2\u003e2.3.9 Intraoperative blood loss\u003c/h2\u003e\u003cp\u003eTwelve studies\u003csup\u003e[18\u0026ndash;19,23\u0026minus;32]\u003c/sup\u003e reported intraoperative blood loss. The findings revealed that the PFBN group experienced less bleeding than the PFNA group did, and the difference was statistically significant (PFNA: \u003cem\u003eSMD\u003c/em\u003e = -0.78, \u003cem\u003e95% CI\u003c/em\u003e -1.53~-0.03, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.04). However, compared with the InterTAN group and the overall control group, the differences were not statistically significant (InterTAN: \u003cem\u003eSMD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.04, \u003cem\u003e95% CI\u003c/em\u003e -0.57\u0026thinsp;~\u0026thinsp;0.64, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.90; Overall: \u003cem\u003eSMD\u003c/em\u003e = -0.57, \u003cem\u003e95% CI\u003c/em\u003e -1.16\u0026thinsp;~\u0026thinsp;0.02, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.06). As shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e10\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section3\"\u003e\u003ch2\u003e2.3.10 Operation duration\u003c/h2\u003e\u003cp\u003eA total of 13 studies\u003csup\u003e[18\u0026ndash;19,22\u0026minus;32]\u003c/sup\u003e reported the operation duration. Although the operation duration in the control group was shorter than that in the PFBN group, the difference was not statistically significant (PFNA: \u003cem\u003eSMD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.24, \u003cem\u003e95% CI\u003c/em\u003e -0.37\u0026thinsp;~\u0026thinsp;0.85, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.44; InterTAN: \u003cem\u003eSMD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.37, \u003cem\u003e95% CI -\u003c/em\u003e0.34\u0026thinsp;~\u0026thinsp;1.08, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.31; Overall: \u003cem\u003eSMD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.28, \u003cem\u003e95% CI\u003c/em\u003e -0.20\u0026thinsp;~\u0026thinsp;0.76, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.26). As shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig11\" class=\"InternalRef\"\u003e11\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section3\"\u003e\u003ch2\u003e2.3.11 Other indicators\u003c/h2\u003e\u003cp\u003eIn terms of other indicators, the analysis results revealed that, except for tip‒apex distance (\u003cem\u003eSMD\u003c/em\u003e = -0.66, \u003cem\u003e95% CI\u003c/em\u003e -1.12~-0.21, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0004), there were no significant differences between the PFBN group and the control group in terms of postoperative hip range of motion, femoral neck‒shaft angle, intraoperative fluoroscopy time, or incision length (flexion and extension: \u003cem\u003eSMD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.28, \u003cem\u003e95% CI\u003c/em\u003e -0.18\u0026thinsp;~\u0026thinsp;0.73, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.23; rotation: \u003cem\u003eSMD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.20, \u003cem\u003e95% CI\u003c/em\u003e -0.25\u0026thinsp;~\u0026thinsp;0.66, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.38; femoral neck‒shaft angle: \u003cem\u003eSMD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.32, \u003cem\u003e95% CI\u003c/em\u003e -0.23\u0026thinsp;~\u0026thinsp;0.87, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.25; intraoperative fluoroscopy time: \u003cem\u003eSMD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.84, \u003cem\u003e95% CI\u003c/em\u003e -0.24\u0026thinsp;~\u0026thinsp;1.92, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.13; incision length: SMD\u0026thinsp;=\u0026thinsp;0.23, \u003cem\u003e95% CI\u003c/em\u003e -0.44\u0026thinsp;~\u0026thinsp;0.89, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.50). As shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003e2.5 Sensitivity analysis\u003c/h2\u003e\u003cp\u003eIn this study, sensitivity analysis was carried out on the above studies with high heterogeneity via leave-one-out and change effect models. The results revealed that all the results were stable and reliable with no significant changes, and no source of heterogeneity was found. The analysis results of the random effects model were acceptable.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003e2.6 Publication bias\u003c/h2\u003e\u003cp\u003eThe operation duration was used as an example to assess publication bias. The funnel plot, which displays a symmetrical funnel shape, indicates that the risk of publication bias in the included studies was not significant. As shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig12\" class=\"InternalRef\"\u003e12\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Findings of this study\u003c/h2\u003e\u003cp\u003eThis study conducted a systematic review and meta-analysis of the clinical efficacy and safety of PFBN compared with PFNA or InterTAN. Compared with previous related research findings, the following characteristics are presented:\u003c/p\u003e\u003cp\u003eIn terms of clinical efficacy, this study indicates that PFBN may have certain advantages in some aspects. Compared with PFNA and InterTAN, PFBN demonstrates superior performance in maintaining the stability of fracture reduction and reducing the time required for fracture healing. It allows for earlier ambulation postoperatively without increasing the risk of internal fixation failure\u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e. This not only aids in patients\u0026rsquo; quicker recovery of physical functions and enhances their independence and autonomy in daily life but also has a positive and profound impact on the overall rehabilitation process. These benefits include the prevention of complications and a reduction in mortality rates\u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e. This may be attributed to its unique biomimetic design, which better conforms to the anatomical structure of the proximal femur, restores the physiological fulcrum position of the proximal femur, provides a more appropriate stress distribution, and offers more sustained and robust fixation\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/sup\u003e. PFNA and InterTAN may not provide ideal fixation for the lateral wall of the IFF, and the spiral blade of its anti-rotating screw is not supported effectively, which may result in a significant increase in cutting stress. This can result in displacement of the femoral head, followed by the four major challenges of \"retrograde nail, rotation, cutting, and instability.\" Subsequently, complications such as failure of internal fixation and varus collapse of the hip may arise\u003csup\u003e[\u003cspan additionalcitationids=\"CR38 CR39\" citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]\u003c/sup\u003e. Since these shortcomings were identified, efforts have been continuously made to explore solutions\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIn terms of safety, the amount of intraoperative blood loss in PFBN is relatively lower than that in PFNA, while there is no significant difference compared with that in InterTAN. The incidence of postoperative complications also exhibited the same characteristics (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig11\" class=\"InternalRef\"\u003e11\u003c/span\u003e). Some studies have also indicated that PFBN has a lower mortality rate than hip replacement does\u003csup\u003e[\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]\u003c/sup\u003e, suggesting that PFBN may have a potential advantage in reducing surgical risk. However, there is also complexity and specificity between different treatment methods, a characteristic that warrants in-depth analysis. PFBN may enhance internal fixation stability and reduce the risk of complications through its more optimized structural design. By triangulating the tension screws and pressure screws, the fractures of the main pressure bone trabeculae are repaired, the shear forces on the main tension bone trabeculae are reduced\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e, and the center of the force arm is closer to the physiological fulcrum\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e. This design aligns the forces more closely with the body's natural mechanics, which can improve the stability of internal fixation and reduce the risk of complications such as loosening or failure of internal fixation\u003csup\u003e[\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]\u003c/sup\u003e. This not only reduces the intraoperative risk but also may have a positive impact on patients\u0026rsquo; early postoperative recovery and reduce the incidence of complications. For example, it can lead to a decrease in anemia-related complications, accelerate postoperative weight bearing, reduce postoperative pain, and mitigate inflammatory responses.\u003c/p\u003e\u003cp\u003eCompared with PFNA and InterTAN, PFBN did not significantly differ in terms of surgical duration, incision length, intraoperative fluoroscopy time, or postoperative hip range of motion (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). These findings suggest that PFBN does not have a clear advantage over PFNA or InterTAN in terms of certain surgical and postoperative recovery indicators and that the overall efficacy of the three internal fixation methods is essentially comparable. As seen from the forest plot, the operative times of PFNA and InterTAN were numerically shorter than that of PFBN, although the difference was not statistically significant. The reason might be that the insertion of transverse support screws has, to some extent, increased the surgical time\u003csup\u003e[\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. Additionally, the surgical duration and length of hospital stay may also vary due to the interactive effects of various other factors, such as the surgeon's experience and technical skill, the patient's physical condition, and postoperative care and rehabilitation management. These factors can significantly influence patient outcomes and should be taken into account when evaluating the overall surgical process and recovery. The length of the surgical incision is likely to be primarily determined by the choice of surgical approach rather than the internal fixation device itself. The number of intraoperative fluoroscopies is likely more closely related to the complexity of the surgery and the surgeon's experience rather than being solely dependent on the type of internal fixation used. Postoperative hip range of motion is more closely associated with factors such as postoperative rehabilitation exercises.\u003c/p\u003e\u003cp\u003eIn summary, PFBN has advantages in terms of early postoperative weight bearing time, fracture healing time, postoperative complication rates, length of hospital stay, and intraoperative blood loss. However, in other aspects, the differences between PFBN and PFNA or InterTAN are not significant. This provides an important reference for the selection of clinical treatment plans. On the basis of the patient's specific conditions and the surgeon's experience, the unique advantages of PFBN can be weighed against the relative consistency in other aspects to formulate the most appropriate surgical strategy.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec25\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Limitations and strengths\u003c/h2\u003e\u003cdiv id=\"Sec26\" class=\"Section3\"\u003e\u003ch2\u003e3.2.1 Strengths of this study:\u003c/h2\u003e\u003cp\u003eAt present, only a small number of efficacy observational studies have been published, with conclusions that are not entirely consistent. There is a notable absence of comprehensive meta-analyses that synthesize the findings from these studies. On the basis of existing clinical studies, this study aims to evaluate the advantages and disadvantages of the efficacy and safety of PFBN compared with PFNA and InterTAN in the treatment of IFF through meta-analysis, providing a valuable reference for the clinical treatment of IFF. This represents the strengths and novel aspects of this study.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec27\" class=\"Section3\"\u003e\u003ch2\u003e3.2.2 Limitations of this study:\u003c/h2\u003e\u003cp\u003eFirst, all the studies included in this paper were cohort studies, which are considered to have a lower level of evidence than randomized controlled trials (RCTs). Second, some studies have relatively short follow-up periods (less than 1 year), which lack long-term assessment and may have a certain impact on the evaluation of outcomes. Third, the sample sizes of the included studies were generally small, and large-sample RCTs to corroborate the findings are lacking. Fourth, owing to the variability in the proficiency of the surgical staff, there may be differences in the assessment of intraoperative indicators such as surgical time and intraoperative blood loss. This study has standardized all the assessment criteria to minimize such impacts. These factors may all potentially influence the level of evidence of the outcomes. In the future, it will be necessary to conduct more rigorously designed, large-sample, multicenter, high-quality RCTs to further validate the clinical efficacy of PFBN.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, PFBN, PFNA, and InterTAN all yield satisfactory therapeutic outcomes in the treatment of intertrochanteric femoral fractures. Moreover, there were no significant differences between PFBN and the other two treatment modalities in terms of surgical duration, postoperative Harris score, intraoperative blood loss, incision length, or hip range of motion. However, PFBN has advantages over control treatments in terms of postoperative weight-bearing time, fracture healing time, quality of fracture reduction, postoperative complication rates, hospital stay, and postoperative VAS score. Therefore, in the future, on the basis of the situation of patients and the experience of surgeons, we can weigh the unique advantages of PFBN and the relative consistency of other aspects to develop the most appropriate surgical strategy to achieve earlier fracture healing and early weight bearing and reduce the occurrence of complications.\u003c/p\u003e\u003cp\u003eNevertheless, the conclusions of this study still require further validation through more rigorously designed, large-sample, multicenter, high-quality RCTs to achieve more reliable results.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003ePFBN:\u003c/strong\u003e Proximal femur bionic nail;\u003cstrong\u003e\u0026nbsp;PFNA:\u0026nbsp;\u003c/strong\u003eProximal femoral nail anti-rotation;\u003cstrong\u003e\u0026nbsp;IFF:\u0026nbsp;\u003c/strong\u003eIntertrochanteric\u0026nbsp;femoral\u0026nbsp;fracture;\u0026nbsp;\u003cstrong\u003eCNKI:\u0026nbsp;\u003c/strong\u003eChina National Knowledge Infrastructure;\u003cstrong\u003e\u0026nbsp;RevMan 5.4:\u0026nbsp;\u003c/strong\u003eReview Manager 5.4; \u003cstrong\u003eVAS:\u0026nbsp;\u003c/strong\u003eVisual analog scale;\u0026nbsp;\u003cstrong\u003eSMD:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eStandardized\u0026nbsp;mean difference; \u003cstrong\u003eCI:\u0026nbsp;\u003c/strong\u003eConfidence interval; \u003cstrong\u003eRR:\u003c/strong\u003e Relative risk;\u0026nbsp;\u003cstrong\u003ePRISMA:\u003c/strong\u003e Preferred Reporting Items for Systematic Reviews and Meta-Analyses;\u0026nbsp;\u003cstrong\u003eNOS:\u0026nbsp;\u003c/strong\u003eNewcastle-Ottawa Quality Assessment Scale; \u003cstrong\u003eRCTs:\u0026nbsp;\u003c/strong\u003eRandomized controlled trials.\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization:\u0026nbsp;WB-Z and YL-M.\u003c/p\u003e\n\u003cp\u003eSearch: WB-Z and FL-L.\u003c/p\u003e\n\u003cp\u003eData extraction and quality assessment: YL-M and WB-Z.\u003c/p\u003e\n\u003cp\u003eStatistical analysis: YL-M and H-S.\u003c/p\u003e\n\u003cp\u003eWriting:\u0026nbsp;WB-Z, FL-L and YL-M.\u003c/p\u003e\n\u003cp\u003eSupervision and\u0026nbsp;modifications: YM-H.\u003c/p\u003e\n\u003cp\u003eRevising the manuscript:\u0026nbsp;WB-Z, FL-L, ZX-Y and XM-D.\u003c/p\u003e\n\u003cp\u003eYL-M, WB-Z, FL-L contributed equally to the study.\u003c/p\u003e\n\u003cp\u003eAll authors reviewed the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was funded by the National Natural Science Foundation of China (project number\u0026nbsp;325021015),\u0026nbsp;the\u0026nbsp;Sichuan Provincial Administration of\u0026nbsp;Traditional\u0026nbsp;Chinese Medicine\u0026nbsp;(project number 2021MS454), the\u0026nbsp;Special Fund\u0026nbsp;for 100 Talents Program of the Affiliated Hospital of Chengdu University of TCM\u0026nbsp;(project number 22-B07), and the\u0026nbsp;Scientific Research Promotion Plan of Xinglin Scholars\u0026nbsp;Discipline Talents of Chengdu University of TCM\u0026nbsp;(project number 030058047).\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no conflicts of interest to disclose.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. This is a data analysis and systematic review of published studies, which does not involve ethical review and does not require the signing of informed consent. Informed consent of participants should be conducted in the original study included in the analysis.\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eConsent for publication\u003c/h3\u003e\n\u003cp\u003eNot applicable.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eavailability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the data generated or analyzed during this study are included in this published article, where specific analytical details and original literature are reasonably available by contacting the first author (Yulin Ma) if necessary.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributor Information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eYulin Ma\u003c/em\u003e, Email: \u003cem\[email protected]\u003c/em\u003e.\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eWenbin Zhang\u003c/em\u003e, Email: \u003cem\[email protected]\u003c/em\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFeilong Lu\u003c/em\u003e, Email: \u003cem\[email protected]\u003c/em\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eHao Song\u003c/em\u003e, Email: \u003cem\[email protected]\u003c/em\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eXiaoming Du, Email:\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\[email protected]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eZhaoxi Yang, Email:\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\[email protected]\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eYimei Hu\u003c/em\u003e, Email: \u003cem\[email protected]\u003c/em\u003e.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eChang SM, Hou ZY, Hu SJ, et al. 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Association of the lateral wall integrity with clinical outcomes in older patients with intertrochanteric hip fractures treated with the proximal femoral nail anti-rotation-Asia. \u003cem\u003eInt Orthop\u003c/em\u003e. 2021; 45(12): 3233-3242. DOI:10.1007/s00264-021-05211-1.\u003c/li\u003e\n\u003cli\u003eChen ZX, Hu CY, Zhen ZH, et al. Effectiveness of proximal femoral nail anti-rotation combined with minimally invasive percutaneous plate osteosynthesis versus Intertan intramedullary nail fixation in treatment of intertrochanteric fracture with incomplete lateral wall. \u003cem\u003eChinese Journal of Reparative and Reconstructive Surgery\u003c/em\u003e, 2020, 34(9): 1085-1090. DOI:10.7507/1002-1892.202001071.\u003c/li\u003e\n\u003cli\u003eChen P, Fan Z, Xu N, et al. A biomechanical investigation of a novel intramedullary nail used to salvage failed internal fixations in intertrochanteric fractures. \u003cem\u003eJ Orthop Surg Res\u003c/em\u003e. 2023;18(1):632. DOI:10.1186/s13018-023-04112-w.\u003c/li\u003e\n\u003cli\u003eSun ZH, Chen D, Chu KW, et al. Comparison of clinical data between the proximal femoral bionic nail (PFBN) and hip replacement for the treatment of femoral intertrochanteric fracture.\u003cem\u003e Eur Rev Med Pharmacol Sci\u003c/em\u003e. 2024; 28(4): 1375-1383. DOI:10.26355/eurrev_202402_35458.\u003c/li\u003e\n\u003cli\u003eZhu YB, Ding K, Li YL, et al. Biomechanical comparison of triangle supporting fixation system and Gamma nail fixation in the treatment of intertrochanteric fractures of the femur: finite element analysis. \u003cem\u003eChin J Orthop\u003c/em\u003e,2021,41(18):1361-1366. DOI:10.3760/cma.j.cn121113-20210601-00394.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Intertrochanteric femoral fracture, Proximal femur bionic nail, Proximal femoral nail anti-rotation, InterTAN, PFBN, PFNA, Meta-analysis","lastPublishedDoi":"10.21203/rs.3.rs-5336804/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5336804/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e To compare the clinical effects and safety of the proximal femur bionic nail (PFBN) with those of proximal femoral nail anti-rotation (PFNA) and InterTAN for the treatment of intertrochanteric femoral fracture (IFF).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e Studies comparing the clinical efficacy of PFBN with that of PFNA and InterTAN in the treatment of IFF published before August 2024 in the PubMed, Embase, Web of Science, Cochrane, CNKI, Wanfang, and VIP databases were retrieved. After the research data were extracted, Review Manager 5.4 (RevMan 5.4) was used for data analysis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e A total of 13 studies involving 825 patients were included. The meta-analysis results indicated that the PFBN group had advantages over the control group in terms of the postoperative partial and full weight-bearing time, fracture healing time, fracture reduction quality, hospital stay, visual analog scale (VAS) score, and postoperative complication rate (partial weight-bearing time: standardized mean difference (\u003cem\u003eSMD\u003c/em\u003e) = -3.06, \u003cem\u003e95%\u003c/em\u003e confidence interval (\u003cem\u003eCI\u003c/em\u003e) -4.02~-2.09, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.00001; full weight-bearing time: \u003cem\u003eSMD\u003c/em\u003e = -1.78, \u003cem\u003e95% CI\u003c/em\u003e -2.86~-0.70, \u003cem\u003eP\u003c/em\u003e = 0.001; fracture healing time: \u003cem\u003eSMD\u003c/em\u003e = -0.55, \u003cem\u003e95% CI\u003c/em\u003e -0.82~-0.28, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.0001; fracture reduction quality: relative risk (\u003cem\u003eRR\u003c/em\u003e) = 1.07, \u003cem\u003e95% CI\u003c/em\u003e 1.01 ~ 1.13, \u003cem\u003eP\u003c/em\u003e = 0.02; hospital stay: \u003cem\u003eSMD\u003c/em\u003e = -0.16, \u003cem\u003e95% CI\u003c/em\u003e -0.33 ~ 0.00, \u003cem\u003eP\u003c/em\u003e = 0.05; postoperative VAS score: \u003cem\u003eSMD\u003c/em\u003e = -0.54, \u003cem\u003e95% CI\u003c/em\u003e -0.90~-0.18, \u003cem\u003eP\u003c/em\u003e = 0.003; postoperative complication rate: \u003cem\u003eRR\u003c/em\u003e = 0.36, \u003cem\u003e95% CI\u003c/em\u003e 0.21 ~ 0.61, \u003cem\u003eP\u003c/em\u003e = 0.0001). There was no significant difference between the two groups in terms of intraoperative blood loss, operation duration, postoperative hip range of motion, postoperative Harris score, intraoperative fluoroscopy time, or incision length (intraoperative blood loss: \u003cem\u003eSMD\u003c/em\u003e = -0.57, \u003cem\u003e95% CI\u003c/em\u003e -1.16 ~ 0.02, \u003cem\u003eP\u003c/em\u003e = 0.06; operation duration: \u003cem\u003eSMD\u003c/em\u003e = 0.28, \u003cem\u003e95% CI\u003c/em\u003e -0.20 ~ 0.76, \u003cem\u003eP\u003c/em\u003e = 0.26; postoperative flexion and extension motion: \u003cem\u003eSMD\u003c/em\u003e = 0.28, \u003cem\u003e95% CI\u003c/em\u003e -0.18 ~ 0.73, \u003cem\u003eP\u003c/em\u003e = 0.23; postoperative rotational motion: \u003cem\u003eSMD\u003c/em\u003e = 0.20, \u003cem\u003e95% CI\u003c/em\u003e -0.25 ~ 0.66, \u003cem\u003eP\u003c/em\u003e = 0.38; postoperative Harris score: \u003cem\u003eSMD\u003c/em\u003e = 0.32, \u003cem\u003e95% CI\u003c/em\u003e 0.00 ~ 0.64, \u003cem\u003eP\u003c/em\u003e = 0.05; intraoperative fluoroscopy time: \u003cem\u003eSMD\u003c/em\u003e = 0.84, \u003cem\u003e95% CI\u003c/em\u003e -0.24 ~ 1.92, \u003cem\u003eP\u003c/em\u003e = 0.13; incision length: SMD = 0.23, \u003cem\u003e95% CI\u003c/em\u003e -0.44 ~ 0.89, \u003cem\u003eP\u003c/em\u003e = 0.50).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e For the treatment of IFF, the PFBN is more effective and has a lower risk than the PFNA and InterTAN.\u003c/p\u003e","manuscriptTitle":"Clinical effects and safety of proximal femur bionic nail versus proximal femoral nail anti-rotation and InterTAN for the treatment of intertrochanteric femoral fracture: a systematic review and meta-analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-09 11:32:47","doi":"10.21203/rs.3.rs-5336804/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6eeb851a-85da-4229-8ab5-9f427b705021","owner":[],"postedDate":"September 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-09T11:32:48+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-09 11:32:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5336804","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5336804","identity":"rs-5336804","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}