Effectiveness of revision surgery following trochanteric fracture fixation in older adults: a systematic review and meta-analysis protocol.

OBJECTIVE: The objective of this review is to evaluate the effect of revision surgical strategies compared on functional outcomes, health-related quality of life, and postoperative complications in patients aged 65 years and older with failed primary fixation of trochanteric femoral fractures. INTRODUCTION: Trochanteric fractures of the femur, including both intertrochanteric and pertrochanteric fractures, are prevalent in older populations and frequently require surgical intervention. Despite initial surgical efforts, failures often occur and revision surgery may be required. ELIGIBILITY CRITERIA: This systematic review will include randomized controlled trials, quasi-experimental designs, prospective and retrospective cohort studies and case control studies. Studies will be included if they assess surgical revision strategies following failed primary fixation of trochanteric femoral fractures, including intertrochanteric and pertrochanteric fractures, in patients aged 65 years and above. Any surgical method for revision will be compared against other surgical revision strategies. METHODS: PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and AgeLine will be searched for eligible studies. Titles and abstracts will be screened, followed by a full-text review of potentially eligible studies by 2 independent reviewers. Critical appraisal of studies will be conducted independently by the same reviewers guided by the JBI critical appraisal tools. Data will be meta-analyzed statistically, if appropriate; where meta-analysis is not possible, vote counting based on the direction of effect will be used as a quantitative synthesis approach, with supporting narrative. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) will be utilized to assess the certainty of the synthesized results. REVIEW REGISTRATION: PROSPERO (CRD420251250047).