Replacement arthroplasty versus internal fixation for extracapsular hip fractures in adults

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Abstract
Background Internal fixation, commonly used for extracapsular hip fractures, may fail particularly in unstable fractures. Replacement of the hip using arthroplasty, often used for intracapsular fractures, has been used as an alternative. Objectives To compare replacement arthroplasty with internal fixation for the treatment of extracapsular hip fractures in adults. Search methods We searched the Cochrane Musculoskeletal Injuries Group specialised register (September 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2004), MEDLINE (1966 to September week 1 2004), EMBASE (1988 to 2004 Week 37), the UK National Research Register Issue 2, 2004, several orthopaedic journals, conference proceedings and reference lists of articles. Selection criteria Randomised and quasi‐randomised trials comparing replacement arthroplasty with an internal fixation implant for skeletally mature people with an extracapsular hip fracture. Data collection and analysis Both reviewers independently assessed 11 aspects of trial quality and extracted data. Additional information was sought from trialists. Relative risks and 95% confidence intervals were calculated for relevant dichotomous outcomes and presented graphically. Main results Only one randomised trial of 90 patients with unstable extracapsular hip femoral fractures in the trochanteric region was identified and included in this review. This compared arthroplasty with a sliding hip screw and was of poor methodological quality. From the limited data available for this trial, there were no significant differences between the two methods of treatment for operating time, local wound complications, re‐operation, mortality rate or mobility or loss of independence of previously independent patients. There was however a higher blood transfusion need in the arthroplasty group. Authors' conclusions There is insufficient evidence from randomised trials to determine whether replacement arthroplasty has any advantage over the sliding hip screw for extracapsular hip fractures. Further well designed randomised trials for the treatment of these fractures for this comparison are required.