Background: Intertrochanteric fractures frequently occur in older patients, and effective care is essential for enhancing outcomes in this at-risk demographic. The aim of this systematic review and meta-analysis was to evaluate the clinical outcomes and consequences linked to PFN and BHA in the management of unstable intertrochanteric fractures in older individuals.

Methods: The research was executed in compliance with PRISMA criteria. A thorough search of electronic databases, such as PubMed, Scopus, Web of Science, and Cochrane Library, was conducted to locate pertinent studies. Eligible studies encompassed senior patients aged 60 to 80 with closed, isolated intertrochanteric fractures, comparing the functional results, comorbidities, and perioperative metrics of PFN and BHA. Essential data on patient demographics, surgical duration, intraoperative hemorrhage, postoperative hospitalization duration, reoperation frequencies, and fatality rates were retrieved and examined.

Results: Twelve papers fulfilled the inclusion criteria, yielding data for qualitative synthesis and meta-analysis. The investigation indicated that PFN typically related to less intraoperative blood loss, abbreviated hospital stays, and enhanced functional results relative to BHA. Nonetheless, BHA provided instant weight-bearing ability, which could be beneficial for patients with restricted life expectancy necessitating swift mobilization.

Conclusion: Both PFN and BHA are effective alternatives for the management of unstable intertrochanteric fractures in geriatric patients. PFN may be advantageous for patients anticipated to have extended recovery durations, as it can facilitate less intraoperative blood loss and enhanced functional results. BHA, however, may be better suitable for individuals necessitating immediate weight-bearing.