Internal fixation implants for intracapsular hip fractures in adults

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Abstract
Numerous different implants with screws, pins and side plates have been used for the internal fixation of intracapsular hip fractures. To determine from randomised trials which implant is superior for the internal fixation of intracapsular proximal femoral fractures. We searched the Cochrane Musculoskeletal Injuries Group specialised register. The date of the most recent search was December 2000. Randomised and quasi-randomised trials comparing different implants for the internal fixation of intracapsular hip fractures in adults. 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. 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. No clear conclusions can be made on the choice of implant for internal fixation of intracapsular fractures from the available evidence within randomised trials.