Intramedullary nailing with and without cerclage in subtrochanteric fractures: an updated systematic review and meta-analysis
Bibliographic record
Abstract
BACKGROUND: Intramedullary nailing (IMN) is the gold standard for femoral subtrochanteric fractures (FSF) treatment due to their biomechanical advantages and minimally invasive nature. However, achieving proper reduction remains challenging in unstable patterns, leading to poor outcomes. Cerclage wiring, used alongside IMN, has shown potential in improving fracture stability and alignment, yet concerns regarding soft tissue damage persist. This systematic review and meta-analysis aims to evaluate the impact of cerclage wiring on clinical and radiological outcomes in FSF treatment. METHODS: A comprehensive literature search was conducted for studies published up to the 3rd of March 2025 using PubMed, Scopus, Google Scholar, and Web of Science databases, focusing on randomized controlled trials and observational studies comparing intramedullary nailing with and without cerclage wiring in subtrochanteric fractures fixation. Eleven eligible studies, encompassing 658 patients, were included. The risk of bias was assessed using the Newcastle–Ottawa scale and meta-analytical techniques were employed to calculate pooled effect sizes and statistical significance. RESULTS: Eleven retrospective studies were included revealing that cerclage wiring significantly increased operative time; p > 0.001, blood loss; p = 0.031, and better functional outcomes as union time significantly decreased; p = 0.026, significantly better Harris Hip Score; p = 0.012, while improving reduction quality. No significant differences were observed in non-union, infection, or mortality rates. Quality assessment using the Newcastle–Ottawa Scale indicated high quality studies. CONCLUSION: Cerclage wiring in conjunction with intramedullary nailing (IMN) for subtrochanteric fractures provides considerable advantages in our study in terms of the quality of fracture reduction, healing duration, and functional rehabilitation, especially in more complicated cases, even though it may lead to longer surgical times and greater blood loss.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.022 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.018 | 0.029 |
| Bibliometrics | 0.010 | 0.010 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".