Comparison of Integrated Dual-lag Screw Versus Single Lag Screw Cephalomedullary Nails for Intertrochanteric Femoral Fractures: A Systematic Review and Meta-Analysis

Division

North Texas

Hospital

Medical City Denton

Document Type

Manuscript

Publication Date

1-20-2026

Keywords

Cephalomedullary nail, Dual lag screw, Femoral fractures, Hip fractures, Intertrochanteric fracture, Single lag screw, Systematic review

Disciplines

Medicine and Health Sciences | Orthopedics | Surgical Procedures, Operative

Abstract

BACKGROUND: To determine whether an integrated dual-lag-screw (IDLS) cephalomedullary nail (CMN) confers superior clinical and mechanical outcomes compared with single-lag-screw (SLS) designs in the fixation of intertrochanteric femoral fractures.

METHODS: Seven databases (MEDLINE, Embase, Cochrane CENTRAL, Web of Science, Google Scholar, ClinicalTrials.gov) were searched from inception through 20 January 2025 following PRISMA guidelines. Randomized trials and comparative observational studies of adult intertrochanteric or subtrochanteric extension fractures treated with IDLS versus SLS nailing and ≥ 6 months follow-up were eligible. Twenty-nine studies met all criteria. Three reviewers independently screened studies, extracted data, and graded quality (ROB-2 for randomized controlled trials, MINORS for non-randomized studies). Random-effects meta-analysis produced pooled odds ratios (OR) for binary outcomes; heterogeneity was assessed with I². Publication bias was explored with funnel plots, trim-and-fill, and Egger's test.

RESULTS: The 29 studies encompassed over 20,000 fractures. Compared with SLS nails, IDLS fixation was associated with significantly fewer implant-related complications (OR 0.55, P = .01), instances of lag-screw cut-out (OR 0.44, P = .016), and cases of lateral hip or thigh pain (OR 0.50, P <  .01). In the unstable-fracture subgroup, IDLS nails similarly showed lower odds of implant-related complications (OR 0.38, P <  .001), revision surgeries (OR 0.37, P = .005), mechanical failure (OR = 0.19, P <  .001), cut-out (OR = 0.19, P <  .001) and post-operative hip/thigh pain (OR = 0.47, P <  .006) compared to SLS nails. No significant evidence of publication bias was detected. Operative time, blood loss, union rate, and 1-year Harris Hip Score were comparable between constructs.

CONCLUSIONS: IDLS CMNs demonstrated markedly lower rates of mechanical failure, revision surgery, and lateral hip/thigh pain, especially in unstable intertrochanteric fracture patterns. These findings support preferential use of IDLS implants in geriatric fragility hip fractures.

LEVEL OF EVIDENCE: Level IV Therapeutic.

Publisher or Conference

Journal of Orthopaedic Surgery and Research

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