OBJECTIVES: Intertrochanteric hip fractures are common and devastating injuries especially for the elderly. We aimed to assess the effectiveness of two commonly used types of intramedullary devices for the treatment of unstable intertrochanteric hip fractures. We hypothesize that fracture constructs using devices that provide additional rotational control for these unstable fractures, will demonstrate a lower rate of construct failure and better outcomes overall. METHODS: A comprehensive systematic literature review and a pairwise meta-analysis of randomised controlled trials (RCTs) and comparative observational studies comparing an Integrated 2 screw de-rotation cepahlo-medulary device * (IDRC) versus a traditional single screw cepahlo-medulary nail** (TSS) was performed. We assessed the following outcomes, revisions, non-unions, post- operative device related complications (shaft fracture, varus collapse and cutouts), hip and thigh pain and health related quality of life (HRQoL). We report odds ratio (OR) for dichotomous outcomes and mean difference (MD) for continuous outcomes. RESULTS: Four studies met the inclusion criteria, 2 RCTs and 2 observational studies (N=533, mean age 75 and 66% women) published between 2013 and 2016. There was no significant difference for revisions [OR 0.53 (95% CI, 0.2 to 1.40) p =0.2] and non-union [OR 0.13 (95% CI, 0.01 to 2.63) p=0.19]. There was a significant difference in implant related failures [OR 0.12 (95% CI, 0.05 to 0.30) p=0.0001) and 60% less people complained of pain OR 0.40 (95% CI, 0.22 to 0.73) p=0.0003 respectively in favour of the integrated 2-screw nail compared to the single screw nail. There was no evidence that study design substantially influenced the estimate of effects. CONCLUSIONS: Our meta-analysis suggests that there is no difference between the two nails on revision and non-union outcomes. The integrated 2-screw de-rotation/compression, cepahlo-medullary device reduces post-operative implant related complications and pain in patients with intertrochanteric fractures compared to the single screw device.

*InterTAN ** Proximal Femoral Nail Antirotation