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. 2001;2001(4):CD001467.
doi: 10.1002/14651858.CD001467.

Internal fixation implants for intracapsular proximal femoral fractures in adults

M J Parker  1 , G Stockton
Affiliations

Internal fixation implants for intracapsular proximal femoral fractures in adults

M J Parker et al. Cochrane Database Syst Rev. 2001.

Abstract

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.

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Conflict of interest statement

Martyn Parker was the lead author of one of the studies included in this review (Parker 2010). The assessment of this study was undertaken by Kurinchi Gurusamy and Helen Handoll. Martyn Parker has received and may continue to receive financial payment from manufacturing companies of orthopaedic implants used for the internal fixation of hip fractures and for attending meeting organised by these companies and for advising on the design and use of hip fracture implants. Kurinchi Gurusamy has no connection with any manufacturing company.

Figures

1
1
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
See this image and copyright information in PMC

References

References to studies included in this review

Alberts 1989 {published data only}
    1. Alberts KA, Jaerveus J, Zyto K. Nail versus screw fixation of femoral neck fractures. A 2‐year radiological and clinical prospective study. Annales Chirurgiae et Gynaecologiae 1989;78:298‐303. - PubMed
Alho 1998(a) {published data only}
    1. Alho A, Austdal S, Benterud JG, Blikra G, Lerud P, Raugstad TS. Biases in a randomized comparison of three types of screw fixation in displaced femoral neck fractures. Acta Orthopaedica Scandinavica 1998;69(5):463‐8. - PubMed
    1. Alho A, Austdal S, Benterud JG, Blikra G, Lerud P, Raugstad TS. Problems in orthopedic multicenter studies ‐ screw fixation of displaced femoral neck fracture [abstract]. Acta Orthopaedica Scandinavica. Supplementum 1998;282:11. - PubMed
    1. Austdal S, Benterud JG, Blikra G, Kuokkanen H, Lindequist S, Lerud P, et al. Osteosynthesis of displaced femoral neck fractures with multiple screws ‐ a randomised multicenter study [abstract]. Journal of Bone and Joint Surgery. British Volume 1993;75 Suppl 2:199.
    1. Benterud J, Alho A. Multiple screw fixation for displaced femoral neck fractures ‐ a multicentre study [abstract]. Journal of Bone and Joint Surgery. British Volume 1995;77 Suppl 2:214.
    1. Benterud JG, Blikra G, Lerud P, Raugstad TS, Austdal S, Lindequist S, et al. Multicentre randomized study on osteosynthesis of femoral neck fractures [abstract]. Acta Orthopaedica Scandinavica. Supplementum 1994;260:32‐3.
Alho 1998(b) {published data only}
    1. Alho A, Austdal S, Benterud JG, Blikra G, Lerud P, Raugstad TS. Biases in a randomized comparison of three types of screw fixation in displaced femoral neck fractures. Acta Orthopaedica Scandinavica 1998;69(5):463‐8. - PubMed
    1. Alho A, Austdal S, Benterud JG, Blikra G, Lerud P, Raugstad TS. Problems in orthopedic multicenter studies ‐ screw fixation of displaced femoral neck fracture [abstract]. Acta Orthopaedica Scandinavica. Supplementum 1998;282:11. - PubMed
    1. Austdal S, Benterud JG, Blikra G, Kuokkanen H, Lindequist S, Lerud P, et al. Osteosynthesis of displaced femoral neck fractures with multiple screws ‐ a randomised multicenter study [abstract]. Journal of Bone and Joint Surgery. British Volume 1993;75 Suppl 2:199.
    1. Benterud J, Alho A. Multiple screw fixation for displaced femoral neck fractures ‐ a multicentre study [abstract]. Journal of Bone and Joint Surgery. British Volume 1995;77 Suppl 2:214.
    1. Benterud JG, Blikra G, Lerud P, Raugstad TS, Austdal S, Lindequist S, et al. Multicentre randomized study on osteosynthesis of femoral neck fractures [abstract]. Acta Orthopaedica Scandinavica. Supplementum 1994;260:32‐3.
Alho 1998(c) {published data only}
    1. Alho A, Austdal S, Benterud JG, Blikra G, Lerud P, Raugstad TS. Biases in a randomized comparison of three types of screw fixation in displaced femoral neck fractures. Acta Orthopaedica Scandinavica 1998;69(5):463‐8. - PubMed
    1. Alho A, Austdal S, Benterud JG, Blikra G, Lerud P, Raugstad TS. Problems in orthopedic multicenter studies ‐ screw fixation of displaced femoral neck fracture [abstract]. Acta Orthopaedica Scandinavica. Supplementum 1998;282:11. - PubMed
    1. Austdal S, Benterud JG, Blikra G, Kuokkanen H, Lindequist S, Lerud P, Raugstad TS, Alho A. Osteosynthesis of displaced femoral neck fractures with multiple screws ‐ a randomised multicenter study [abstract]. Journal of Bone and Joint Surgery. British Volume 1993;75 Suppl 2:199.
    1. Benterud J, Alho A. Multiple screw fixation for displaced femoral neck fractures ‐ a multicentre study [abstract]. Journal of Bone and Joint Surgery. British Volume 1995;77 Suppl 2:214.
    1. Benterud JG, Blikra G, Lerud P, Raugstad TS, Austdal S, Lindequist S, et al. Multicentre randomized study on osteosynthesis of femoral neck fractures [abstract]. Acta Orthopaedica Scandinavica. Supplementum 1994;260:32‐3.
Benterud 1997 {published data only}
    1. Alho A, Benterud JG, Ronningen H, Hoiseth A. Prediction of disturbed healing in femoral neck fracture: radiographic analysis of 149 cases. Acta Orthopaedica Scandinavica 1992;63(6):639‐44. - PubMed
    1. Benterud JG, Alho A. Displaced femoral neck fracture treated with HCS or Olmed screws ‐ 225 randomized patients followed for 3 years [abstract]. Acta Orthopaedica Scandinavica. Supplementum 1994;256:18.
    1. Benterud JG, Husby T, Nordsletten L, Alho A. Fixation of displaced femoral neck fractures with a sliding screw plate and a cancellous screw or two Olmed screws ‐ A prospective, randomized study of 225 elderly patients with a 3‐year follow‐up. Annales Chirurgiae et Gynaecologiae 1997;86(4):338‐42. - PubMed
Christie 1988 {published data only}
    1. Christie J, Howie CR, Armour PC. Fixation of displaced subcapital femoral fractures. Compression screw fixation versus double divergent pins. Journal of Bone and Joint Surgery. British Volume 1988;70(2):199‐201. - PubMed
    1. Howie CR, Christie J, Watson H. A prospective randomised trial of compression screw fixation versus double divergent pin fixation for displaced subcapital fracture of the femur [abstract]. Journal of Bone and Joint Surgery. British Volume 1987;69(3):490.
Dalen 1985 {published data only}
    1. Dalen N, Jacobsson B. Factors influencing the incidence of reoperation after femoral neck fractures. International Orthopaedics 1985;9:235‐7. - PubMed
    1. Jacobsson B, Dalen N, Jonsson B, Ackerholm P. Intraarticular pressure during operation of cervical hip fractures. Acta Orthopaedica Scandinavica 1988;59(1):16‐8. - PubMed
Elmerson 1988 {published data only}
    1. Elmerson S, Gunnar BJ, Andersson J, Irstam L, Zetterberg C. Internal fixation of femoral neck fracture. No difference between the Rydell four‐flanged nail and Gouffon's pins. Acta Orthopaedica Scandinavica 1988;59(4):372‐6. - PubMed
Elmerson 1995 {published data only}
    1. Elmerson S, Sjostedt A, Zetterberg C. Fixation of femoral neck fracture. A randomized 2‐year follow‐up study of hook pins and sliding screw plate in 222 patients. Acta Orthopaedica Scandinavica 1995;66(6):507‐10. - PubMed
Frandsen 1981 {published data only}
    1. Frandsen PA. Osteosynthesis of displaced fractures of the femoral neck. A comparison between Smith‐Petersen Osteosynthesis and sliding‐nail‐plate osteosynthesis ‐ a radiological study. Acta Orthopaedica Scandinavica 1979;50(4):443‐9. - PubMed
    1. Frandsen PA, Andersen Jr PE. Treatment of displaced fractures of the femoral neck. Smith‐Petersen osteosynthesis versus sliding‐nail‐plate osteosynthesis. Acta Orthopaedica Scandinavica 1981;52(5):547‐52. - PubMed
Harper 1992 {published data only}
    1. Harper WM. A prospective randomised trial comparing multiple parallel cannulated screws with a sliding hip screw and plate. In 'Treatment of intracapsular proximal femoral fractures'. Thesis. Leicester: University of Leicester, 1994:158‐86.
    1. Harper WM, Gregg PJ. The treatment of intracapsular proximal femoral fractures: a randomized prospective trial [abstract]. Journal of Bone and Joint Surgery. British Volume 1992;74 Suppl 3:282.
Herngren 1992 {published data only}
    1. Herngren B, Mork‐Petersen F, Bauer M. Uppsala screws or Hansson pins for internal fixation of femoral neck fractures? A prospective study of 180 cases. Acta Orthopaedica Scandinavica 1992;63(1):41‐6. - PubMed
Holmberg 1990 {published data only}
    1. Holmberg S, Mattsson P, Dahlborn M, Ersmark H. Fixation of 220 femoral neck fractures. A prospective comparison of the Rydell nail and the LIH hook pins. Acta Orthopaedica Scandinavica 1990;61(2):154‐7. - PubMed
Kuokkanen 1991 {published data only}
    1. Kuokkanen H, Korkala O, Antti‐Poika I, Tolonen J, Lehtimaki MY, Silvennoinen T. Three cancellous bone screws versus a screw‐angle plate in the treatment of Garden I and II fractures of the femoral neck. Acta Orthopaedica Belgica 1991;57:53‐7. - PubMed
Lagerby 1998 {published data only}
    1. Lagerby M, Asplund S, Ringqvist I. Cannulated screws for fixation of femoral neck fractures: No difference between Uppsala screws and Richards screws in a randomized prospective study of 268 cases. Acta Orthopaedica Scandinavica 1998;69(4):387‐91. - PubMed
Lindequist 1989 {published data only}
    1. Lindequist S, Malmqvist B, Ullmark G. Fixation of femoral neck fracture. Prospective comparison of von Bahr screws, Gouffon screws and Hessel pins [published erratum appears in Acta Orthopaedica Scandinavica 1989 Aug;60(4):507‐508]. Acta Orthopaedica Scandinavica 1989;60(3):293‐8. - PubMed
Lykke 2003 {published data only}
    1. Lykke N, Lerud PJ, Stromsoe K, Thorngren K‐G. Fixation of fracture of the femoral neck: a prospective, randomised trial of three Ullevaal hip screws versus two Hansson hook‐pins. Journal of Bone Joint Surgery. British Volume 2003;85:426‐30. - PubMed
Madsen 1987 {published data only}
    1. Linde F, Andersen E, Hvass I, Madsen F, Pallesen R. Avascular femoral head necrosis following fracture fixation. Injury 1986;17:159‐63. - PubMed
    1. Madsen F, Linde F, Andersen E, Birke H, Hvass I, Poulsen TD. Fixation of displaced femoral neck fractures. A comparison between sliding screw plate and four cancellous bone screws. Acta Orthopaedica Scandinavica 1987;58:212‐6. - PubMed
    1. Madsen F, Linde F, Andersen E, Birke H, Hvass I, Poulsen TD. Sliding screw plate versus four ASIF cancellous bone screws in the treatment of displaced femoral neck fractures [abstract]. Acta Orthopaedica Scandinavica 1986;57:598‐9. - PubMed
Mjorud 2006 {published data only}
    1. Mjorud J, Skaro O, Solhaug JH, Thorngren K‐G. A randomised study in all cervical hip fractures. Osteosynthesis with Hansson hook‐pins versus AO‐screws in 199 consecutive patients followed for two years. Injury 2006;37(8):768‐77. - PubMed
Nordkild 1985 {published data only}
    1. Nordkild P, Sonne‐Holm S, Jensen JS. Femoral neck fracture: sliding screw plate versus sliding nail plate ‐a randomized trial. Injury 1985;16:449‐54. - PubMed
    1. Sonne‐Holm S, Nordkild P, Dyrbye M, Jensen JS. The predictive value of bone scintigraphy after internal fixation of femoral neck fractures. Injury 1987;18:33‐5. - PubMed
    1. Sonne‐Holm S, Nordkild P, Dyrbye M, Jensen JS. The predictive value of bone scintigraphy after internal fixation of femoral neck fractures [abstract]. Acta Orthopaedica Scandinavica 1986;57:181.
Olerud 1991 {published data only}
    1. Hellqvist E, Olerud C, Rehnberg L. Hansson pins vs Uppsala screws in treating femoral neck fractures [abstract]. Acta Orthopaedica Scandinavica. Supplementum 1990;61(237):56.
    1. Olerud C, Rehnberg L. Femoral neck fractures: Swedish experience. In: Marti RK, Dunki Jacobs PB editor(s). Proximal femoral fractures: operative techniques and complications. Vol. 1, London: Medical Press, 1993:219‐40.
    1. Olerud C, Rehnberg L, Hellquist E. Internal fixation of femoral neck fractures. Two methods compared. Journal of Bone and Joint Surgery. British Volume 1991;73:16‐9. - PubMed
Ovesen 1997 {published data only}
    1. Ovesen O, Poulsen TD, Andersen I. Uppsala screws versus dynamic hip screw for internal fixation of femoral neck fractures [abstract]. Journal of Bone and Joint Surgery. British Volume 1997;79 Suppl 2:244.
    1. Ovesen O, Poulsen TD, Andersen I, Jensen PE, Damholt UW. Uppsala screws versus dynamic hip screw for internal fixation of femoral neck fractures [abstract]. Acta Orthopaedica Scandinavica. Supplementum 1997;274:40.
Parker 2010 {published data only}
    1. Parker MJ. personal communication October 29 2010.
    1. Parker MJ, Ali SM. Short versus long thread cannulated cancellous screws for intracapsular hip fractures: a randomised trial of 432 patients. Injury 2010;41(4):382‐4. - PubMed
Paus 1986 {published data only}
    1. Paus A, Gjengedal E, Hareide A, Jorgensen JJ. Dislocated fractures of the femoral neck treated with von Bahr screws or hip compression screw. Results of a prospective, randomized study. Journal of the Oslo City Hospitals 1986;36:55‐61. - PubMed
Rehnberg 1989 {published data only}
    1. Olerud C, Rehnberg L. Femoral neck fractures: Swedish experience. In: Marti Rk, Dunki Jacobs PB editor(s). Proximal femoral fractures: operative techniques and complications. Vol. 1, London: Medical Press, 1993:207‐19.
    1. Rehnberg L, Olerud C. A new method for osteosynthesis prevents early complications in cervical hip fractures [Ny osteosyntesmetod minskar de tidiga komplikationerna vid cervikala hoftfrakturer]. Lakartidningen 1988;85:3820‐1. [MEDLINE: ] - PubMed
    1. Rehnberg L, Olerud C. Femoral neck fractures: A prospective randomized comparison of von Bahr and Uppsala screws [abstract]. Acta Orthopaedica Scandinavica. Supplementum 1990;237:55.
    1. Rehnberg L, Olerud C. Fixation of femoral neck fractures. Comparison of the Uppsala and von Bahr screws. Acta Orthopaedica Scandinavica 1989;60:579‐84. - PubMed
Sernbo 1990 {published data only}
    1. Sernbo I, Holmquist H, Redlund‐Johnell I, Johnell O. Radiographic prediction of failure after fixation of cervical hip fracture. Acta Orthopaedica Scandinavica 1994;65(3):295‐8. - PubMed
    1. Sernbo I, Johnell O, Baath L, Nilsson JA. Internal fixation of 410 cervical hip fractures. A randomized comparison of a single nail versus two hook‐pins. Acta Orthopaedica Scandinavica 1990;61(5):411‐4. - PubMed
Sorensen 1992 {published data only}
    1. Sorensen JL, Varmarken JE, Bomler J. Internal fixation of femoral neck fractures. Dynamic Hip and Gouffon screws compared in 73 patients. Acta Orthopaedica Scandinavica 1992;63(3):288‐92. - PubMed
    1. Varmarken JE, Sorensen JL, Bomler J. Internal fixation of femoral neck fractures; a randomised comparison of Dynamic Hip Screw and Gouffon Pins [abstract]. Acta Orthopaedica Scandinavica. Supplementum 1992;63(247):35‐6. - PubMed
Sorensen 1996 {published data only}
    1. Sorensen AI, Scavenius M, Aagaard H, Ronnebech J, Torholm C. Dynamic hip screw versus Hook‐pins versus Uppsala screws in treatment of fracture of the cervical neck [abstract]. Acta Orthopaedica Scandinavica. Supplementum 1996;267:30.
Stromquist 1988 {published data only}
    1. Roos H, Hansson LI, Ohlin P, Stromquist B. Screws or hook pins in femoral neck fracture fixation? [abstract]. Acta Orthopaedica Scandinavica 1986;57:250.
    1. Stromquist B, Roos H, Hansson LI, Ohlin P. Fixation of fractures of the femoral neck using screws or hook‐pins. Radionuclide study and short‐term results [Fixation des fractures du col femoral par vissage ou "broches en crochet". Etude scintimetrique et resultats a court terme. Fixation des fractures du col femoral par vissage ou "broches en crochet". Etude scintimetrique et resultats a court terme.]. Revue de Chirurgie Orthopedique et Reparatrice de L'appareil Moteur 1988;74:609‐13. [MEDLINE: ] - PubMed
Stromqvist 1984 {published data only}
    1. Stromqvist B. Femoral head vitality after intracapsular hip fracture. 490 cases studied by intravital tetracycline labelling and Tc‐MDP radionuclide imaging. Acta Orthopaedica Scandinavica 1983;54(Suppl 200):17. - PubMed
    1. Stromqvist B, Hansson LI, Nilsson LT, Thorngren K‐G. Two‐year follow‐up of femoral neck fractures with special reference to type of osteosynthesis. Acta Orthopaedica Scandinavica 1984;55:712‐3. - PubMed
    1. Stromqvist B, Hansson LI, Nilsson LT, Thorngren KG. Two‐year follow‐up of femoral neck fractures. Comparison of osteosynthesis methods. Acta Orthopaedica Scandinavica 1984;55:521‐5. - PubMed
    1. Stromqvist B, Hansson LI, Palmer J, Ceder L, Thorngren KG. Scintimetric evaluation of nailed femoral neck fractures with special reference to type of osteosynthesis. Acta Orthopaedica Scandinavica 1983;54:340‐7. - PubMed
Svenningsen 1984 {published data only}
    1. Benum P, Nesse O, Svenningsen S. Fracture of the neck of the femur. A randomized prospective study [abstract]. Acta Orthopaedica Scandinavica 1980;51:371.
    1. Svenningsen S, Benum P, Nesse O, Furset OI. Femoral neck fractures in the elderly ‐ a comparison of 3 treatment methods [Larhalsbrudd hos eldre‐‐en sammenligning av tre behandlingsmetoder]. Nordisk Medicin 1985;100:256‐9. [MEDLINE: ] - PubMed
    1. Svenningsen S, Benum P, Nesse O, Furset OI. Femoral neck fractures in the elderly. A comparison of 3 therapeutic methods [Larhalsbrudd hos eldre. En sammenligning av tre behandlingsmetoder]. Tidsskr for den Norske Laegeforening 1985;105(7):492‐5. [MEDLINE: ] - PubMed
    1. Svenningsen S, Benum P, Nesse O, Furset OI. Internal fixation of femoral neck fractures. Compression screw compared with nail plate fixation. Acta Orthopaedica Scandinavica 1984;55:423‐9. - PubMed
Wihlborg 1990 {published data only}
    1. Wihlborg O. Fixation of femoral neck fractures. A four‐flanged nail versus threaded pins in 200 cases. Acta Orthopaedica Scandinavica 1990;61(5):415‐8. - PubMed

References to studies excluded from this review

Ingwersen 1992 {published data only}
    1. Ingwersen J, Skoglund A, Syversen S. Early loss of fixation of cervical hip fractures [abstract]. Acta Orthopaedica Scandinavica. Supplementum 1992;247:6‐7.
Jukkala‐Partio 2000 {published data only}
    1. Jukkala‐Partio K, Partio EK, Helevirta P, Pohjonen T, Tormala P, Rokkanen P. Treatment of subcapital femoral neck fractures with bioabsorbable or metallic screw fixation. Annals Chirurgiae et Gynaecologiae 2000;89:45‐52. - PubMed
Poulsen 1995 {published data only}
    1. Poulsen TD, Ovesen O, Andersen I. Percutaneous osteosynthesis with two screws in treating femoral neck fractures. Orthopedics 1995;18(7):661‐4. - PubMed
Sernbo 1986 {published data only}
    1. Sernbo I, Edwards P, Johnell O, Baath L. Cannulated screws versus spring loaded single nail in cervical hip fractures: A prospective randomized trial [abstract]. Acta Orthopaedica Scandinavica 1986;57:598.

References to ongoing studies

FAITH {unpublished data only}
    1. Bhandari M. Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH): a multi‐centre randomised trial comparing sliding hip screws and cancellous screws on revision surgery rates and quality of life in the treatment of femoral neck fractures. http://apps.who.int/trialsearch/Trial.aspx?TrialID=ISRCTN25524122 (accessed 18 January 2011). - PMC - PubMed

Additional references

Alho 1998
    1. Alho A, Austdal S, Benterud JG, Blikra G, Lerud P, Raugstad TS. Biases in a randomized comparison of three types of screw fixation in displaced femoral neck fractures. Acta Orthopaedica Scandinavica 1998;69(5):463‐8. - PubMed
Harris 1969
    1. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mould arthroplasty. An end‐result study using a new method of result evaluation. Journal of Bone and Joint Surgery. American Volume 1969;51‐A(4):737‐55. - PubMed
Lefebvre 2009
    1. Lefebvre C, Manheimer E, Glanville J. Chapter 6.4.11 Search filters. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2 (updated September 2009). The Cochrane Collaboration, 2009. Available from www.cochrane‐handbook.org.
Lu‐Yao 1994
    1. Lu‐Yao GL, Keller RB, Littenberg B, Wennberg JE. Outcome after displaced fracture of the femoral neck: a meta‐analysis of one hundred and six published reports. Journal of Bone and Joint Surgery. American Volume 1994;76‐A:15‐25. - PubMed
Parker 1993
    1. Parker MJ, Pryor GA. Hip fracture management. Oxford: Blackwell Scientific Publications, 1993.
Tronzo 1974
    1. Tronzo RG. Hip nails for all occasions. The Orthopedic Clinics of North America 1974;5:479‐91. - PubMed

Publication types