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Extramedullary fixation implants and external fixators for extracapsular hip fractures.
1Orthopaedic Department, Peterborough District Hospital, Thorpe Road, Peterborough, Cambridgeshire, UK, PE3 6DA. mjparker@doctors.org.uk
The Cochrane Database of Systematic Reviews
|January 10, 2003
Summary
The sliding hip screw (SHS) demonstrates a lower risk of fixation failure compared to fixed nail plates for hip fractures. While evidence is limited for other devices, SHS appears preferable due to reduced failure rates.
Area of Science:
- Orthopedic surgery
- Biomedical engineering
- Trauma care
Background:
- Extramedullary fixation uses plates and screws for proximal femur fractures.
- External fixators stabilize fractures externally using pins or screws.
Purpose of the Study:
- Compare extramedullary fixation implants and external fixators for adult extracapsular hip fractures.
Main Methods:
- Systematic review of randomized or quasi-randomized trials up to July 2002.
- Independent quality assessment and data extraction by two reviewers.
- Pooling of data from comparable trials where appropriate.
Main Results:
- Fixed nail plates showed increased fixation failure risk versus the sliding hip screw (SHS).
- Contrasting results between RAB plate and SHS regarding complications and restoration.
- Medoff plate showed lower fixation failure for unstable trochanteric fractures; no significant differences for other outcomes.
- Gotfried plate had higher intra-operative failure rates but lower blood loss.
- External fixation suggested less operative trauma and faster recovery than SHS, with similar final outcomes.
Conclusions:
- SHS is preferable due to lower fixation failure rates compared to fixed nail plates.
- Insufficient evidence exists to definitively compare SHS with RAB, Pugh, Medoff plates, or external fixators.
- Further high-quality randomized trials are needed for definitive comparisons.