[Objective]To compare the clinical efficacy between distal locked and unlocked intramedullary nailing in the treatment of femoral intertrochanteric fracture.[Method]The data bases,such as China National Knowledge Infrastructure(CNKI),Wanfang database,VIP database,China Biological Literature system(CBM),PubMed,Embase,and Cochrane library were searched for the comparison of clini-cal outcomes of distal locked versus unlocked intramedullary nailing in the treatment of intertrochanteric fracture from the creating to Octo-ber 2022.Literature screening,quality assessment,and data extraction were conducted to meet the inclusion and exclusion criteria,and Rev-Man 5.3 was used to perform the meta-analysis of parameters related to the consequences.[Results]A total of 9 studies were included with 1 977 patients treated with intramedullary nail fixation for femoral intertrochanteric fractures,including 830 cases in the distal locked group and 1 147 cases in the distal unlocked group.As results of the meta-analysis,the unlocked group proved significantly superior to the locked group in terms of operation time(MD=7.5,95％CI 5.0～10.1,P＜0.001),intraoperative bleeding(MD=37.6,95％CI 20.1～55.2,P＜0.001),fluoroscopy times(MD=6.8,95％CI 4.4～9.2,P＜0.001)and total incision length(MD=2.5,95％CI 2.1～2.9,P＜0.001),whereas the unlocked group had significantly lower incidence of postoperative thigh pain than the locked group(RR=4.7,95％CI 2.4～9.2,P＜0.001).However,there was no significant difference in complications,such as delayed fracture healing,hip pain,wound infection,screw cutting,peri-implant fractures between the two groups(P＞0.05).In addition,there was no significant difference in Harris score between the two groups at the last follow-up(P＞0.05).[Conclusion]For femoral intertrochanteric fractures(31A1+A2),the distal unlocked intramedullary nails can ensure stable fixation,while reducing intraoperative injury and reducing the incidence of postoperative thigh pain.
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