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Internal fixation implants for intracapsular proximal femoral fractures in adults
1Orthopaedic Department, Peterborough District Hospital, Thorpe Road, Peterborough, Cambridgeshire, UK, PE3 6DA. mjparker@doctors.org.uk
Insights
This review found no significant difference between implants for hip fracture fixation. The sliding hip screw showed longer operative times and more blood loss than multiple screws or pins.
Area of Science:
- Orthopedic surgery
- Traumatology
- Biomedical engineering
Background:
- Intracapsular hip fractures are commonly treated with internal fixation devices.
- Various implants, including screws, pins, and side plates, have been utilized.
Purpose of the Study:
- To compare the efficacy of different implants for internal fixation of intracapsular proximal femoral fractures using randomized trials.
- To identify a superior implant for treating these fractures.
Main Methods:
- Systematic review of randomized and quasi-randomized trials identified through the Cochrane Musculoskeletal Injuries Group specialized register (search up to December 2000).
- Independent assessment of trial quality and data extraction by two reviewers.
- Data pooling using a fixed-effects model after grouping and subgrouping by implant type.
Main Results:
- Twenty-seven studies with 5269 participants were analyzed, revealing significant methodological variations and potential biases.
- No implant demonstrated significant superiority in fracture healing complications or mortality outcomes.
- The sliding hip screw was associated with longer operative times and increased blood loss compared to multiple screws or pins.
Conclusions:
- The available evidence from randomized trials is insufficient to definitively conclude which implant is superior for internal fixation of intracapsular hip fractures.
- Further high-quality research is needed to guide clinical decision-making regarding implant choice.
Background:
Numerous different implants with screws, pins and side plates have been used for the internal fixation of intracapsular hip fractures.
Objectives:
To determine from randomised trials which implant is superior for the internal fixation of intracapsular proximal femoral fractures.
Search Strategy:
We searched the Cochrane Musculoskeletal Injuries Group specialised register. The date of the most recent search was December 2000.
Selection Criteria:
Randomised and quasi-randomised trials comparing different implants for the internal fixation of intracapsular hip fractures in adults.
Data Collection And Analysis:
Two reviewers independently assessed trial quality, by use of a ten item scale, and extracted data. Additional information was sought from trialists. After grouping by implant type, comparable groups of trials were subgrouped and where appropriate, data were pooled using the fixed effects model.
Main Results:
Twenty-seven studies involving 5269 participants (5274 fractures) were included in the study. Considerable variation in the quality of methodology between studies was found and biases due to familiarity with some of the implants were noted. None of the implants tested were found to be significantly superior for any of the outcome measures related to fracture healing complications or mortality. The sliding hip screw was found to take longer to insert and to have an increased operative blood loss compared with multiple screws or pins.
Reviewer'S Conclusions:
No clear conclusions can be made on the choice of implant for internal fixation of intracapsular fractures from the available evidence within randomised trials.