Locking compression plate fixation versus intramedullary nailing for subtrochanteric femoral fractures: a meta-analysis

Abstract

Background:

Subtrochanteric femoral fractures (SFF) are challenging to manage due to their complex anatomy and high complication rates. Various surgical techniques, including locking compression plate fixation (LCPF) and intramedullary nailing (IMN), have been used, but there is no consensus on the optimal treatment method.

Objective:

To compare perioperative outcomes, radiological parameters, and functional recovery between LCPF and IMN in patients with SFF.

Methods:

A comprehensive search was conducted on PubMed, Scopus, Cochrane Library, and Google Scholar from inception through March 2025. 5 studies comprising 341 patients (185 LCPF and 156 IMN) met the inclusion criteria. Primary outcomes included intraoperative blood loss, operative time, hip flexion, varus malalignment, time to full weight-bearing, hospital stay, malunion, nonunion, postoperative complications, and Harris Hip Score (HHS).

Results:

IMN showed significantly lower blood loss (MD: 147.53 mL; p < 0.001), shorter hospital stay (MD: 4.73 days; p < 0.001), and better HHS (MD: −4.49 points; p = 0.02) compared with LCPF. LCPF was associated with shorter operative time (MD: 11.93 minutes; p = 0.03). No significant differences were observed in hip flexion, varus malalignment, nonunion, or overall complication rates.

Conclusions:

Both LCPF and IMN provide acceptable outcomes in the management of SFF. However, IMN offers significant advantages in reducing intraoperative blood loss, shortening hospital stay, and enhancing early functional recovery. These findings suggest that IMN may be the preferable option, particularly in patients at higher risk for perioperative morbidity. Further large-scale, prospective randomised studies are warranted to validate these conclusions and establish definitive treatment guidelines.