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Meta-Analysis
. 2006 Oct 18;2006(4):CD001708.
doi: 10.1002/14651858.CD001708.pub2.

Internal fixation versus arthroplasty for intracapsular proximal femoral fractures in adults

M J Parker  1 , K Gurusamy
Affiliations
Meta-Analysis

Internal fixation versus arthroplasty for intracapsular proximal femoral fractures in adults

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

Abstract

Background: Displaced intracapsular fractures may be treated by either reduction and internal fixation, which preserves the femoral head, or by replacement of the femoral head with an arthroplasty.

Objectives: To review all randomised controlled trials that have compared internal fixation with arthroplasty for intracapsular femoral fractures in adults.

Search strategy: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (December 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2005, Issue 4), MEDLINE, EMBASE, the UK National Research Register, several orthopaedic journals, conference proceedings and reference lists of articles. We contacted trialists where possible.

Selection criteria: All randomised and quasi-randomised controlled trials comparing internal fixation with arthroplasty for intracapsular hip fractures in adults.

Data collection and analysis: Trial quality was assessed by use of a 10 item scale. At least two review authors independently assessed trial quality and extracted data. Additional information was sought from trialists. After grouping into three broad categories, comparable groups of trials were subgrouped and where appropriate, data were pooled using the fixed-effect model.

Main results: Seventeen trials involving 2694 participants were included. Length of surgery, operative blood loss, need for blood transfusion and risk of deep wound infection were significantly less for internal fixation compared with arthroplasty. Arthroplasty had a significantly lower re-operation rate in comparison with fixation. No definite differences for hospital stay, mortality, or regain of same residential state were found. Limited information from some studies suggested pain was less and function was better for a cemented arthroplasty in comparison to fixation.

Authors' conclusions: Internal fixation is associated with less initial operative trauma but has an increased risk of re-operation on the hip. Definite conclusions cannot be made for differences in pain and residual disability between the two groups. Future studies should concentrate on better reporting of final outcome measures and there is still a need for studies to define which patient groups are better served by the different treatment methods.

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Conflict of interest statement

Martyn Parker has received and may continue to receive financial payment from manufacturing companies of orthopaedic implants 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. Martyn Parker was the lead investigator in one of the included trials, assessment of eligibility of this trial and the subsequent quality assessment was done independently by the other review author.

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

Update of

References

References to studies included in this review

Blomfeldt 2005 {published data only}
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Parker 2002 {published and unpublished data}
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Roden 2003 {published data only}
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Soreide 1979 {published data only}
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STARS 2006 {published data only}
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Svenningsen 1985 {published data only}
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Tidermark 2003 {published data only}
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van Dortmont 2000 {published data only}
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References to studies excluded from this review

Bray 1988 {published data only}
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El‐Abed 2005 {published data only}
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Hunter 1969 {published data only}
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Hunter 1974 {published data only}
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Neander 2000 {published and unpublished data}
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Parker 1992 {published data only}
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Pathi 1989 {published data only}
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Riley 1978 {published data only}
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Rodriguez 1987 {published data only}
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Additional references

Bhandari 2003
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References to other published versions of this review

Masson 2002
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Parker 2006
    1. Parker MJ, Gurusamy KS. Internal fixation versus arthroplasty for intracapsular proximal femoral fractures in adults. Cochrane Database of Systematic Reviews 2006, Issue 4. [DOI: 10.1002/14651858.CD001708.pub2] - DOI - PMC - PubMed

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