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. 2022 Jan 26;1(1):CD000093.
doi: 10.1002/14651858.CD000093.pub6.

Cephalomedullary nails versus extramedullary implants for extracapsular hip fractures in older adults

Sharon R Lewis  1 , Richard Macey  2 , James R Gill  3 , Martyn J Parker  4 , Xavier L Griffin  1   5
Affiliations

Cephalomedullary nails versus extramedullary implants for extracapsular hip fractures in older adults

Sharon R Lewis et al. Cochrane Database Syst Rev. .

Abstract

Background: Hip fractures are a major healthcare problem, presenting a substantial challenge and burden to patients, healthcare systems and society. The increased proportion of older adults in the world population means that the absolute number of hip fractures is rising rapidly across the globe. Most hip fractures are treated surgically. This Cochrane Review evaluates evidence for implants used to treat extracapsular hip fractures.

Objectives: To assess the relative effects of cephalomedullary nails versus extramedullary fixation implants for treating extracapsular hip fractures in older adults.

Search methods: We searched CENTRAL, MEDLINE, Embase, Web of Science, the Cochrane Database of Systematic Reviews, Epistemonikos, ProQuest Dissertations & Theses, and the National Technical Information Service in July 2020. We also searched clinical trials databases, conference proceedings, reference lists of retrieved articles, and conducted backward-citation searches.

Selection criteria: We included randomised controlled trials (RCTs) and quasi-RCTs comparing cephalomedullary nails with extramedullary implants for treating fragility extracapsular hip fractures in older adults. We excluded studies in which all or most fractures were caused by a high-energy trauma or specific pathologies other than osteoporosis.

Data collection and analysis: We used standard methodological procedures expected by Cochrane. We collected data for seven critical outcomes: performance of activities of daily living (ADL), delirium, functional status, health-related quality of life, mobility, mortality (reported within four months of surgery as 'early mortality'; and reported from four months onwards, with priority given to data at 12 months, as '12 months since surgery'), and unplanned return to theatre for treating a complication resulting directly or indirectly from the primary procedure (such as deep infection or non-union). We assessed the certainty of the evidence for these outcomes using GRADE. MAIN RESULTS: We included 76 studies (66 RCTs, 10 quasi-RCTs) with a total of 10,979 participants with 10,988 extracapsular hip fractures. The mean ages of participants in the studies ranged from 54 to 85 years; 72% were women. Seventeen studies included unstable trochanteric fractures; three included stable trochanteric fractures only; one included only subtrochanteric fractures; and other studies included a mix of fracture types. More than half of the studies were conducted before 2010. Owing to limitations in the quality of reporting, we could not easily judge whether care pathways in these older studies were comparable to current standards of care. We downgraded the certainty of the outcomes because of high or unclear risk of bias; imprecision (when data were available from insufficient numbers of participants or the confidence interval (CI) was wide); and inconsistency (when we noted substantial levels of statistical heterogeneity or differences between findings when outcomes were reported using other measurement tools). There is probably little or no difference between cephalomedullary nails and extramedullary implants in terms of mortality within four months of surgery (risk ratio (RR) 0.96, 95% CI 0.79 to 1.18; 30 studies, 4603 participants) and at 12 months (RR 0.99, 95% CI 0.90 to 1.08; 47 studies, 7618 participants); this evidence was assessed to be of moderate certainty. We found low-certainty evidence for differences in unplanned return to theatre but this was imprecise and included clinically relevant benefits and harms (RR 1.15, 95% CI 0.89 to 1.50; 50 studies, 8398 participants). The effect estimate for functional status at four months also included clinically relevant benefits and harms; this evidence was derived from only two small studies and was imprecise (standardised mean difference (SMD) 0.02, 95% CI -0.27 to 0.30; 188 participants; low-certainty evidence). Similarly, the estimate for delirium was imprecise (RR 1.22, 95% CI 0.67 to 2.22; 5 studies, 1310 participants; low-certainty evidence). Mobility at four months was reported using different measures (such as the number of people with independent mobility or scores on a mobility scale); findings were not consistent between these measures and we could not be certain of the evidence for this outcome. We were also uncertain of the findings for performance in ADL at four months; we did not pool the data from four studies because of substantial heterogeneity. We found no data for health-related quality of life at four months. Using a cephalomedullary nail in preference to an extramedullary device saves one superficial infection per 303 patients (RR 0.71, 95% CI 0.53 to 0.96; 35 studies, 5087 participants; moderate-certainty evidence) and leads to fewer non-unions (RR 0.55, 95% CI 0.32 to 0.96; 40 studies, 4959 participants; moderate-certainty evidence). However, the risk of intraoperative implant-related fractures was greater with cephalomedullary nails (RR 2.94, 95% CI 1.65 to 5.24; 35 studies, 4872 participants; moderate-certainty evidence), as was the risk of later fractures (RR 3.62, 95% CI 2.07 to 6.33; 46 studies, 7021 participants; moderate-certainty evidence). Cephalomedullary nails caused one additional implant-related fracture per 67 participants. We noted no evidence of a difference in other adverse events related or unrelated to the implant, fracture or both. Subgroup analyses provided no evidence of differences between the length of cephalomedullary nail used, the stability of the fracture, or between newer and older designs of cephalomedullary nail.

Authors' conclusions: Extramedullary devices, most commonly the sliding hip screw, yield very similar functional outcomes to cephalomedullary devices in the management of extracapsular fragility hip fractures. There is a reduced risk of infection and non-union with cephalomedullary nails, however there is an increased risk of implant-related fracture that is not attenuated with newer designs. Few studies considered patient-relevant outcomes such as performance of activities of daily living, health-related quality of life, mobility, or delirium. This emphasises the need to include the core outcome set for hip fracture in future RCTs.

Trial registration: ClinicalTrials.gov NCT01238068.

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Conflict of interest statement

SL has no known conflicts of interest.

RM has no known conflicts of interest.

JG has no known conflicts of interest.

MP has received and may continue to receive financial payment from manufacturing companies of orthopaedic implants, for attending meetings organised by these companies and for advising on the design and use of hip fracture implants. He has remained independent of study selection decisions, risk of bias assessments, and data extraction of any of the studies on which he is an author, co‐applicant or has had an advisory role.

XG is funded by a National Institute for Health Research Clinician Scientist Grant. Further funding from industry and charitable grants are and have been made available to his institution. All decisions relating to the design, conduct, analysis, write‐up, and publication of research are independent of these funders. He has ongoing expert consultancy with several companies; none involve the development of any implant for use in hip fracture care. He has remained independent of study selection decisions, risk of bias assessments, and data extraction of any of the studies on which he is an author, co‐applicant, or has had an advisory role.

Figures

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1
Flow diagram. Search conducted in November 2018 and December 2018, with a top‐up search in July 2020.
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study. Blank spaces in the figure indicate that 'Risk of bias' judgements were not made because study authors did not report data for these outcomes.
3
3
4
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5
5
6
6
7
7
8
8
9
9
Postoperative periprosthetic fractures: subgrouped according to date of publication
1.1
1.1. Analysis
Comparison 1: Cephalomedullary nails versus extramedullary implants, Outcome 1: ADL, early (≤ 4 months)
1.2
1.2. Analysis
Comparison 1: Cephalomedullary nails versus extramedullary implants, Outcome 2: ADL (≤ 4 months; independent in performance of ADL)
1.3
1.3. Analysis
Comparison 1: Cephalomedullary nails versus extramedullary implants, Outcome 3: ADL, early (≤ 4 months; change in social dependency scale)
1.4
1.4. Analysis
Comparison 1: Cephalomedullary nails versus extramedullary implants, Outcome 4: ADL at 12 months
1.5
1.5. Analysis
Comparison 1: Cephalomedullary nails versus extramedullary implants, Outcome 5: ADL (12 months; independent in performance of ADL)
1.6
1.6. Analysis
Comparison 1: Cephalomedullary nails versus extramedullary implants, Outcome 6: ADL at 12 months (change scores in social dependency scale
1.7
1.7. Analysis
Comparison 1: Cephalomedullary nails versus extramedullary implants, Outcome 7: Delirium
1.8
1.8. Analysis
Comparison 1: Cephalomedullary nails versus extramedullary implants, Outcome 8: Functional status, early (≤ 4 months)
1.9
1.9. Analysis
Comparison 1: Cephalomedullary nails versus extramedullary implants, Outcome 9: Functional status, early (≤ 4 months; excellent or good)
1.10
1.10. Analysis
Comparison 1: Cephalomedullary nails versus extramedullary implants, Outcome 10: Functional status at 12 months (mean scores)
1.11
1.11. Analysis
Comparison 1: Cephalomedullary nails versus extramedullary implants, Outcome 11: Functional status (12 months; excellent or good using HHS)
1.12
1.12. Analysis
Comparison 1: Cephalomedullary nails versus extramedullary implants, Outcome 12: HRQoL at 12 months
1.13
1.13. Analysis
Comparison 1: Cephalomedullary nails versus extramedullary implants, Outcome 13: Mobility (≤ 4 months; independent mobility)
1.14
1.14. Analysis
Comparison 1: Cephalomedullary nails versus extramedullary implants, Outcome 14: Mobility, early (≤ 4 months; mobility scales, mean scores)
1.15
1.15. Analysis
Comparison 1: Cephalomedullary nails versus extramedullary implants, Outcome 15: Mobility (≤ 4 months; 10 metre walking speed test)
1.16
1.16. Analysis
Comparison 1: Cephalomedullary nails versus extramedullary implants, Outcome 16: Mobility (≤ 4 months; able to complete TUG)
1.17
1.17. Analysis
Comparison 1: Cephalomedullary nails versus extramedullary implants, Outcome 17: Mobility, early (≤ 4 months; TUG, mean scores)
1.18
1.18. Analysis
Comparison 1: Cephalomedullary nails versus extramedullary implants, Outcome 18: Mobility at 12 months (mobility scales, mean scores)
1.19
1.19. Analysis
Comparison 1: Cephalomedullary nails versus extramedullary implants, Outcome 19: Mobility (at 12 months; change from baseline)
1.20
1.20. Analysis
Comparison 1: Cephalomedullary nails versus extramedullary implants, Outcome 20: Mobility (12 months; independent mobility)
1.21
1.21. Analysis
Comparison 1: Cephalomedullary nails versus extramedullary implants, Outcome 21: Mobility (12 months; able to complete TUG)
1.22
1.22. Analysis
Comparison 1: Cephalomedullary nails versus extramedullary implants, Outcome 22: Mobility at 12 months (TUG, mean scores)
1.23
1.23. Analysis
Comparison 1: Cephalomedullary nails versus extramedullary implants, Outcome 23: Failure to regain pre‐fracture mobility (at 12 months)
1.24
1.24. Analysis
Comparison 1: Cephalomedullary nails versus extramedullary implants, Outcome 24: Mobility at 12 months (remained in bed or wheelchair)
1.25
1.25. Analysis
Comparison 1: Cephalomedullary nails versus extramedullary implants, Outcome 25: Mortality, early (≤ 4 months)
1.26
1.26. Analysis
Comparison 1: Cephalomedullary nails versus extramedullary implants, Outcome 26: Mortality at 12 months
1.27
1.27. Analysis
Comparison 1: Cephalomedullary nails versus extramedullary implants, Outcome 27: Unplanned return to theatre
1.28
1.28. Analysis
Comparison 1: Cephalomedullary nails versus extramedullary implants, Outcome 28: Pain, early (≤ 4 months; pain scales, mean scores)
1.29
1.29. Analysis
Comparison 1: Cephalomedullary nails versus extramedullary implants, Outcome 29: Experiencing pain (≤ 4 months)
1.30
1.30. Analysis
Comparison 1: Cephalomedullary nails versus extramedullary implants, Outcome 30: Pain at 12 months (pain scales, mean scores)
1.31
1.31. Analysis
Comparison 1: Cephalomedullary nails versus extramedullary implants, Outcome 31: Experiencing pain (at 12 months)
1.32
1.32. Analysis
Comparison 1: Cephalomedullary nails versus extramedullary implants, Outcome 32: Length of hospital stay (days)
1.33
1.33. Analysis
Comparison 1: Cephalomedullary nails versus extramedullary implants, Outcome 33: Discharge destination (to own home/previous residence)
1.34
1.34. Analysis
Comparison 1: Cephalomedullary nails versus extramedullary implants, Outcome 34: Adverse event related to implant, fracture, or both
1.35
1.35. Analysis
Comparison 1: Cephalomedullary nails versus extramedullary implants, Outcome 35: Adverse events unrelated to implant, fracture, or both
2.1
2.1. Analysis
Comparison 2: Cephalomedullary nails versus extramedullary implants: subgrouped by short or long intramedullary nails, Outcome 1: Functional status at 12 months (mean scores)
2.2
2.2. Analysis
Comparison 2: Cephalomedullary nails versus extramedullary implants: subgrouped by short or long intramedullary nails, Outcome 2: Mobility at 12 months (mobility scales, mean scores)
2.3
2.3. Analysis
Comparison 2: Cephalomedullary nails versus extramedullary implants: subgrouped by short or long intramedullary nails, Outcome 3: Mobility (12 months; independent mobility)
2.4
2.4. Analysis
Comparison 2: Cephalomedullary nails versus extramedullary implants: subgrouped by short or long intramedullary nails, Outcome 4: Early mortality
2.5
2.5. Analysis
Comparison 2: Cephalomedullary nails versus extramedullary implants: subgrouped by short or long intramedullary nails, Outcome 5: Mortality at 12 months
2.6
2.6. Analysis
Comparison 2: Cephalomedullary nails versus extramedullary implants: subgrouped by short or long intramedullary nails, Outcome 6: Unplanned return to theatre
3.1
3.1. Analysis
Comparison 3: Cephalomedullary nails versus extramedullary implants: subgrouped by stable and unstable fractures, Outcome 1: Functional status at 12 months (mean scores)
3.2
3.2. Analysis
Comparison 3: Cephalomedullary nails versus extramedullary implants: subgrouped by stable and unstable fractures, Outcome 2: Mobility at 12 months (mobility scales, mean scores)
3.3
3.3. Analysis
Comparison 3: Cephalomedullary nails versus extramedullary implants: subgrouped by stable and unstable fractures, Outcome 3: Mobility (12 months; independent mobility)
3.4
3.4. Analysis
Comparison 3: Cephalomedullary nails versus extramedullary implants: subgrouped by stable and unstable fractures, Outcome 4: Early mortality
3.5
3.5. Analysis
Comparison 3: Cephalomedullary nails versus extramedullary implants: subgrouped by stable and unstable fractures, Outcome 5: Mortality at 12 months
3.6
3.6. Analysis
Comparison 3: Cephalomedullary nails versus extramedullary implants: subgrouped by stable and unstable fractures, Outcome 6: Unplanned return to theatre
4.1
4.1. Analysis
Comparison 4: Intraoperative and postoperative periprosthetic fractures: subgrouped by year of publication, Outcome 1: Intraoperative periprosthetic fracture
4.2
4.2. Analysis
Comparison 4: Intraoperative and postoperative periprosthetic fractures: subgrouped by year of publication, Outcome 2: Postoperative periprosthetic fracture
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Update of

References

References to studies included in this review

Adams 2001 {published and unpublished data}
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Aktselis 2014 {published data only}
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Baumgaertner 1998 {published and unpublished data}
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Benum 1994 {published data only}
    1. Aune AK, Ekeland A, Odegaard B, Grogaard B, Alho A.Gamma nail vs compression screw for trochanteric femoral fractures. 15 reoperations in a prospective, randomized study of 378 patients. Acta Orthopaedica Scandinavica 1994;65:127-30. [PMID: ] - PubMed
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Bridle 1991 {published data only}
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Butt 1995 {published data only}
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Cai 2016 {published data only}
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Calderon 2013 {published data only}
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Chechik 2014 {published data only}
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Chen 2018 {published data only}
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Davis 1988 {published data only}
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Dujardin 2001 {published data only}
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Ekstrom 2007 {published data only}
    1. Ekstrom W, Karlsson-Thur C, Larsson S, Ragnarsson B, Alberts K-A.Functional outcome in treatment of unstable trochanteric and subtrochanteric fractures with the proximal femoral nail and the Medoff sliding plate. Journal of Orthopaedic Trauma 2007;21(1):18-25. [PMID: ] - PubMed
Giraud 2005 {published and unpublished data}
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Goldhagen 1994 {published data only}
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Gou 2013 {published data only}
    1. Guo Q, Shen Y, Zong Z, Zhao Y, Liu H, Hua X, et al.Percutaneous compression plate versus proximal femoral nail anti-rotation in treating elderly patients with intertrochanteric fractures: a prospective randomized study. Journal Orthopaedic Science 2013;18(6):977-86. [PMID: ] - PMC - PubMed
Guerra 2014 {published data only}
    1. Guerra M, Pasqualin S, Souza M, Lenz R.Functional recovery of elderly patients with surgically-treated intertrochanteric fractures: preliminary results of a randomised trial comparing the dynamic hip screw and proximal femoral nail techniques. Injury 2014;45(Suppl 5):S26-S31. [PMID: ] - PubMed
Guyer 1991 {published data only}
    1. Guyer P, Landolt M, Eberle C, Keller H.The gamma-nail as a resilient alternative to the dynamic hip screw in unstable proximal femoral fractures in the elderly [Der Gamma-nagel als belastungsstabile alternative zur DHS bei der instabilen proximalen femurfraktur des alten menschen]. Helvetica Chirurgica Acta 1991;58(5):697-703. [PMID: ] - PubMed
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    1. Guyer P, Landolt M, Keller H, Eberle Ch.The Gamma nail in per-and intertrochanteric femoral fractures - alternative or complementary to the DHS? A prospective randomised study. In: Marti RK, Dunki Jacobs PB, editors(s). Proximal femoral fractures. Operative technique and complications. Vol. 2. London: Medical Press Limited, 1993:481-98. [PMID: ] - PubMed
    1. Guyer P, Landolt M, Kelter H, Eberle C.Gamma-nails verses DHS be per- and intertrochateral femur fractures. Hefte zur der Unfallchirurg 1993;230:854-6.
Han 2012 {published data only}
    1. Han G, Wei W, Gu J.Comparison of proximal femoral locking plate and Gamma nail in the treatment of the femoral intertrochanteric fractures in the elder. China Journal of Orthopaedic Trauma 2012;25(10):796-9. [PMID: ] - PubMed
Haq 2014 {published data only}
    1. Haq RU, Manhas V, Pankaj A, Srivastava A, Dhammi IK, Jain AK.Proximal femoral nails compared with reverse distal femoral locking plates in intertrochanteric fractures with a compromised lateral wall; a randomised controlled trial. International Orthopaedics 2014;38(7):1443-9. [PMID: ] - PMC - PubMed
Hardy 1998 {published data only}
    1. Ridder VA, Lange S.Use of an intramedullary hip-screw compared with a compression hip-screw with a plate for intertrochanteric femoral fractures. A prospective, randomized study of one hundred patients [letter; comment]. Journal of Bone and Joint Surgery. American Volume 1999;81(10):1502-3. [PMID: ] - PubMed
    1. Hardy DC, Delince P.Intramedullary hip screw (IMHS) versus compression hip screw plate (CHSP) for intertrochanteric hip fractures. A prospective, randomised trial of 160 patients [Abstract]. Journal of Bone and Joint Surgery. British Volume 1999;81(Suppl 2):163-4.
    1. Hardy DC, Descamps P, Krallis P, Fabeck L, Smets P, Bertens CL, et al.Use of an intramedullary hip-screw compared with a compression hip-screw with a plate for intertrochanteric femoral fractures. A prospective, randomised study of one hundred patients. Journal of Bone and Joint Surgery. American Volume 1998;80(5):618-30. [PMID: ] - PubMed
Harrington 2002 {published and unpublished data}
    1. Harrington P, Nihal A, Singania A, Howell F.Compression hip syndrome or intramedullary hip screw for unstable peri-trochanteric fractures? A prospective randomised study [abstract]. Journal of Bone and Joint Surgery. British Volume 1999;81(Suppl 3):296.
    1. Harrington P, Nihal A, Singhania AK, Howell FR.Intramedullary hip screw versus sliding hip screw for unstable intertrochanteric femoral fractures in the elderly. Injury 2002;33(1):23-8. [PMID: ] - PubMed
Haynes 1996 {unpublished data only}
    1. Haynes RC.Internal hip fracture fixation systems [PhD thesis]. Bath (UK): University of Bath, 1996.
Hoffman 1996 {published and unpublished data}
    1. Hoffman CW, Lyndskey TG.Intertrochanteric fractures of the femur; a randomised prospective comparison of the gamma nail and the Ambi hip screw [abstract]. Journal of Bone and Joint Surgery. British Volume 1993;75 Suppl 1:50. [PMID: ] - PubMed
    1. Hoffman CW, Lynskey TG.Intertrochanteric fractures of the femur: a randomized prospective comparison of the Gamma nail and the Ambi hip screw. New Zealand Journal of Surgery 1996;66(3):151-5. [PMID: ] - PubMed
Hoffmann 1999 {published data only}
    1. Hoffmann R, Schmidmaier G, Schulz R, Schutz M, Sudkamp NP.Classic nail versus DHS. A prospective randomised study of fixation of trochanteric femur fractures [Classic-Nagel vs. dynamische Huftschraube (DHS). Eine prospektiv-randomisierte Studie zur Behandlung pertrochantarer Femurfrakturen.]. Unfallchirurg 1999;102:182-90. [PMID: ] - PubMed
Hong 2011 {published data only}
    1. Hong JY, Suh SW, Park JH, Shin YS, Yoon JR, Yang JH.Comparison of soft-tissue serum markers in stable intertrochanteric fracture: dynamic hip screw versus proximal femoral nail—A preliminary study. Injury 2011;42(2):204-8. [PMID: ] - PubMed
Kouvidis 2012 {published data only}
    1. Kouvidis G, Sakellariou, Mavrogenis AF, Stavrakakis J, Kampas D, Galanakis J, et al.Dual lag screw cephalomedullary nail versus the classic sliding hip screw for the stabilisation of intertrochanteric fractures. A prospective randomized study. Strategies in Trauma and Limb Reconstruction 2012;7:155-62. [PMID: ] - PMC - PubMed
Kukla 1997 {published and unpublished data}
    1. Kukla C, Berger G.Randomised comparison of the Gamma nail and the Dynamic Hip Screw in 120 patients over 60 years of age. In: Gahr RH, Leung WS, Rosenwasser MO, Roth W, editors(s). The Gamma locking nail - ten years results and surgical experience. Reinbek:Einhorn-Presse Verlag, 1999:294-302.
    1. Kukla C, Heinz T, Berger G, Kwasny O, Rosenberger A, Vecsei V.Gamma nail vs. Dynamic Hip Screw in 120 patients over 60 years - a randomized trial. Acta Chirurgica Austriaca 1997;29(5):290-3. [DOI: 10.1007/BF02621324] - DOI
    1. Kukla C, Heinz T, Berger G, Kwasny O, Wien A.Prospective randomised comparison of the Gamma nail and DHS in 120 patients [Prospektiv randomisierter vergleich zwischen Gammanagel und DHS bei 120 Patienten]. In: Rommens PM, Vecsei V, editors(s). Osteosynthese International. Leuven: Leuven University Press, 1994:265-8.
    1. Vecsei V, Kukla C, Heinz T.Gamma-Nail versus DHS: prospective randomised comparison in 120 cases [abstract]. In: 5th International Orthopaedic and Trauma Meeting. Combined meeting of Austrian Trauma Association and Malaysian Orthopaedic Association; 1995 Oct 26-31; Kuala Lumpur. 1995:1-2.
    1. Vecsei V, Kukla C, Heinz T.Gamma nail versus DHS - a prospective randomised trial of 120 patients [abstract]. Journal of Bone and Joint Surgery. British Volume 1995;77 Suppl 2:136.
Kuwabara 1998 {published data only}
    1. Kuwabara H, Wada T, Minagi Y, Iwasaki T, Tsuji H.Compression hip screw and gamma nail for intertrochanteric fractures - randomized prospective study. Hokkaido Journal of Orthopaedics & Traumatology 1998;40(2):29-33.
Leung 1992 {published and unpublished data}
    1. Leung KS, So WS, Shen WY, Hui PW.Gamma nails and dynamic hip screws for peritrochanteric fractures. A randomised prospective study in elderly patients. Journal of Bone and Joint Surgery. British Volume 1992;74(3):345-51. [PMID: ] - PubMed
Li 2018 {published data only}
    1. Li H, Wang Q, Dai GG, Peng H.PFNA vs. DHS helical blade for elderly patients with osteoporotic femoral intertrochanteric fractures. European Review for Medical and Pharmacological Sciences 2018;22:1-7. [PMID: ] - PubMed
Little 2008 {published data only}
    1. Fernando JC, Khaleel A, Elliot D.Holland nail vs DHS in intertrochanteric femoral fractures [abstract]. Journal of Bone and Joint Surgery. British Volume 2006;88(Suppl 1):71.
    1. Little NJ, Verma V, Fernando C, Elliott DS, Khaleel A.A prospective trial comparing the Holland nail with the dynamic hip screw in the treatment of intertrochanteric fractures of the hip. Journal of Bone and Joint Surgery. British Volume 2008;90(8):1073-8. [PMID: ] - PubMed
Lopez 2002 {published data only}
    1. Lopez FM, Lopez XP, Casas OG, Valencia MR, Vao AL, Soleda JB.Prospective, comparative, randomized study of the sliding screw and Gamma nail in the treatment of pertrochanteric fractures [Estudio prospectivo aleatorio comparativo del tornillo deslizante y el clavo gamma en el tratamiento de las fracturas pertrocantereas]. Revista de Ortopedia y Traumatologia 2002;46(6):505-9.
Matre 2013 {published data only}
    1. Matre K, Vinje T, Havelin LI, Gjertsen, Furnes O, Espehaug B, et al.Pain, function, and complications after operations with a sliding hip screw or an intertan nail for trochanteric and subtrochanteric fractures. A prospective randomized multicentre study with one year follow-up. In: Orthopaedic Proceedings. Vol. 94-B. September 2012:230.
    1. Matre K, Vinje T, Havelin LI, Gjertsen J, Furnes O, Espehaug B, et al.Trigen intertan intramedulllary nail versus sliding hip screw. A prospective, randomised multicenter study on pain, function and complications in 684 patients with an intertrochanteric or subtrochanteric fracture and one year follow-up. Journal of Bone and Joint Surgery. American volume 2013;95:200-8. [DOI: 10.2106/JBJS.K.01497] - DOI - PubMed
Mehdi 2000 {published data only}
    1. Kinninmonth A.Comparison of the intramedullary hip screw with Richard's classic hip screw in the management of pertrochanteric hip fractures. In: National Research Register, Issue 2, 2001. Oxford: Update Software.
    1. Mehdi SA, Kinninmonth AWG, MacLeod C, McKenzie E, James PJ.Extracapsular hip fracture fixation: a prospective randomised comparison of the intramedullary hip screw with the sliding hip screw [abstract]. Injury 2000;31:287.
    1. Mehdi SA.personal communication 24 April 2006.
Michos 2001 {published data only}
    1. Michos I, Brakoulakis E, Pastroudis A, Loutriotis A, Adamopoulos G.The Gamma nail system compared to sliding nail and plate for peritrochanteric fractures [abstract]. Journal of Bone and Joint Surgery. British Volume 2001;83(Suppl 2):193.
Miedel 2005 {published data only}
    1. Miedel R, Ponzer S, Tornkvist H, Soderqvist A, Tidermark J.The standard Gamma nail or the Medoff sliding plate for unstable trochanteric and sub-trochanteric fractures: a randomised, controlled trial. Journal of Bone and Joint Surgery. British Volume 2005;87(1):68-75. [DOI: 10.1302/0301-620X.87B1.15295] - DOI - PubMed
    1. Tidermark J, Miedel R, Ponzer S, Tornkvist H.The standard Gamma nail or the Medoff sliding plate for unstable trochanteric and sub-trochanteric fractures: a randomized controlled trial [abstract]. In: Orthopaedic Trauma Association Annual Meeting; 2004 Oct 8-10; Hollywood, Florida. 2004.
Mott 1993 {published data only}
    1. Mott MP, Kronik JL, Fitzgerald RH Jr, Morawa LG, Georgiadis GM, Salot WH.Gamma nail versus the sliding hip screw: A prospective randomized comparison [abstract]. Orthopaedic Transactions 1993;17:1049.
O'Brien 1995 {published and unpublished data}
    1. O'Brien PJ, Meek RN, Blachut PA, Broekhuyse HM, Sabharwal S.Fixation of intertrochanteric hip fractures: Gamma nail versus dynamic hip screw. A randomised, prospective study. Canadian Journal of Surgery 1995;38(6):516-20. [PMID: ] - PubMed
    1. O'Brien PJ, Meek RN, Blachut PA, Broekhuyse HM, Sabharwal S.Intertrochanteric hip fracture fixation - Gamma nail vs dynamic hip screw. A randomized, prospective study [abstract]. Orthopaedic Transactions 1994;18(1):19. - PubMed
    1. Sabharwal S, O'Brien PJ, Meek RN, Blackut PA, Broekhuyse HM.Intertrochanteric hip fracture fixation - Gamma nail versus dynamic hip screw. A randomized prospective study [abstract]. Journal of Bone and Joint Surgery. British Volume 1992;74 Suppl 3:281.
Ovesen 2006 {published and unpublished data}
    1. Ovesen O, Andersen M, Poulsen T, Nymark T, Overgaard S, Rock ND.The trochanteric gamma nail versus the dynamic hip screw: a prospective randomised study. One-year follow-up of 146 intertrochanteric fractures. Hip International 2006;16(4):293-8. [PMID: ] - PubMed
    1. Ovesen O.personal communication 25 June 2007.
    1. Svenson O, Andersen M, Poulsen T, Nymark T, Overgaard S, Rock ND.A prospective randomised study comparing the trochanteric gamma nail (TGN) and the dynamic hip screw (DHS) in 146 intertrochanteric fractures [abstract]. Journal of Bone and Joint Surgery. British Volume 2006;88 Suppl 1:70.
Pahlpatz 1993 {published data only}
    1. Pahlplatz PVM, Langius FB.Comparing the Gamma nail and the Dynamic Hip Screw in the treatment of pertrochanteric fractures. Preliminary results of a prospective randomised study. In: Marti RK, Dunki Jacobs PB, editors(s). Proximal femoral fractures. Operative technique and complications. Vol. 2. London, UK: Medical Press Limited, 1993:475-80.
Pajarinen 2005 {published data only}
    1. Pajarinen J, Lindahl J, Michelsson O, Savolainen V, Hirvensalo E.Pertrochanteric femoral fractures treated with a dynamic hip screw or a proximal femoral nail; a randomised study comparing post-operative rehabilitation. Journal of Bone and Joint Surgery. British Volume 2005;87(1):76-81. [PMID: ] - PubMed
    1. Pajarinen J, Lindahl J, Savolainen V, Michelsson O, Hirvensalo E.Femoral shaft medialisation and neck-shaft angle in unstable pertrochanteric femoral fractures. International Orthopaedics 2004;28(6):347-53. [PMID: ] - PMC - PubMed
    1. Pajarinen J.personal communication 24 February 2005.
Papasimos 2005 {published data only}
    1. Papasimos S, Koutsojannis CM, Panagopoulos A, Megas P, Lambiris E.A randomised comparison of AMBI, TGN and PFN for treatment of unstable trochanteric fractures. Archives of Orthopaedic and Trauma Surgery 2005;125(7):462-8. [PMID: ] - PubMed
Park 1998 {published data only}
    1. Kang JS, Park SR, Lee WH, Kim YH.Treatment of intertrochanteric fracture with the Gamma AP nail [poster]. In: Final programme of the 20th World Congress SICOT; 1996 Aug 18-23; Amsterdam. 1996:315.
    1. Park SR, Kang JS, Kim HS, Lee WH.Treatment of intertrochanteric fracture with the Gamma AP locking nail or by a compression hip screw - a randomised prospective trial. International Orthopaedics 1998;22(3):157-60. [PMID: ] - PMC - PubMed
Parker 2012 {published data only}
    1. Parker MJ, Bowers TR, Pryor GA.Sliding hip screw versus the Targon PF nail in the treatment of trochanteric fractures of the hip; a randomised trial of 600 fractures. The Journal of Bone & Joint Surgery 2012;94(3):391-7. [PMID: ] - PubMed
Parker 2017 {published data only}
    1. Parker M.Intramedullary fixation with a third generation nail versus the sliding hip screw for trochanteric hip fractures; a randomised trial of 400 patients. Orthopaedic Proceedings January 2011;Vol. 93-B:22.
    1. Parker M.Intramedullary fixation with a third generation nail versus the sliding hip screw for trochanteric hip fractures: a randomised trial of 400 patients. Orthopaedic Proceedings 2010;Vol. 92-B:556.
    1. Parker MJ, Cawley S.Sliding hip screw versus the Targon PFT nail for trochanteric hip fractures. Bone and Joint Journal 2017;99(9):1210-5. [PMID: ] - PubMed
    1. Parker MJ.Sliding hip screw versus intramedullary nail for trochanteric hip fractures; a randomised trial of 1000 patients with presentation of results related to fracture stability. Injury 2017;48(12):2762-7. [PMID: ] - PubMed
Pelet 2001 {published data only}
    1. Pelet S, Arlettaz Y, Chevalley F.Osteosynthesis of per- and subtrochanteric fractures by blade plate versus gamma nail. A randomized prospective study. Swiss Surgery 2001;7(3):126-33. [PMID: ] - PubMed
Radford 1993 {published data only}
    1. Radford PJ, Needoff M, Webb JK.A prospective randomised comparison of the dynamic hip screw and the gamma locking nail. Journal of Bone and Joint Surgery. British Volume 1993;75(5):789-93. [PMID: ] - PubMed
    1. Radford PJ, Needoff M, Webb JK.The Gamma nail compared to the dynamic hip screw for pertrochanteric fractures of the femur [abstract]. Journal of Bone and Joint Surgery. British Volume 1992;74 Suppl 2:133-4.
    1. Radford PJ, Needoff M.Intramedullary or extramedullary fixation for pertrochanteric fractures of the femur? [abstract]. Journal of Bone and Joint Surgery. British Volume 1992;74(Suppl 3):281.
Rahme 2007 {published data only}
    1. Harris I, Rahme D.A prospective randomised controlled trial of subtrochanteric femur fractures treated with a proximal femoral nail compared to a 95-degree blade plate [abstract]. Journal of Bone and Joint Surgery. British Volume 2005;87(Suppl 3):310-1.
    1. Rahme DM, Harris IA.Intramedullary nailing versus fixed angle blade plating for subtrochanteric femoral fractures: a prospective randomised controlled trial. Journal of Orthopaedic Surgery 2007;15(3):278-81. [PMID: ] - PubMed
Raimondo 2012 {published data only}
    1. Raimondo E, Marchesi L, Pelis A, Grisone B, Giubilato A, Pietrogrande L.Minimally invasive surgical techniques in the treatment of proximal femoral fractures: PCCP plate versus ITST nail. A prospective randomized matched study. Journal of Orthopaedics and Traumatology 2013;13 Suppl 1:S57-S89. [DOI: 10.1007/s10195-012-0210-2] - DOI
Reindl 2015 {published data only}
    1. NCT00597779.Randomised comparison of 2 fixation techniques for unstable intertrochanteric hip fractures (EMvsIM). clinicaltrials.gov/show/NCT00597779 (first received 18 January 2008).
    1. Reindl R, Harvey EJ, Berry GK, Rahme E.Intramedullary versus extramedullary fixation for unstable intertrochanteric fractures: a prospective randomized controlled trial. Journal of Bone and Joint Surgery. American volume 2015;97:1905-12. [PMID: ] - PubMed
Sadowski 2002 {published and unpublished data}
    1. Sadowski C, Lubbeke A, Saudan M, Riand N, Stern R, Hoffmeyer P.Treatment of reverse oblique and transverse intertrochanteric fractures with use of an intramedullary nail or a 95 degree screw-plate. Journal of Bone and Joint Surgery. American Volume 2002;84(3):372-81. [PMID: ] - PubMed
    1. Saudan M, Lubecke A, Sadowski Ch, Riand N, Stern R, Hoffmeyer P.Is there an indication for intramedullary fixation of intertrochanteric fractures? [abstract]. In: European Federation of National Associations of Orthopaedics and Traumatology; 2001 Jun 1-7; Rhodes (Greece). 2001.
Sanders 2017 {published data only}
    1. Sanders D, Bryant D, Tieszer C, Lawendy AR, MacLeod M, Papp S et al.Multicenter randomized control trial comparing a novel intramedullary device (InterTAN) versus conventional treatment (Sliding Hip Screw) of geriatric hip fractures. Journal of Orthopaedic Trauma 2017;31(1):1-8. [PMID: ] - PubMed
Saudan 2002 {published and unpublished data}
    1. Saudan M, Lubbeke A, Sadowski C, Riand N, Stern R, Hoffmeyer P.Pertrochanteric fractures: is there an advantage to an intramedullary nail? A randomized, prospective study of 206 patients comparing the dynamic hip screw and proximal femoral nail. Journal of Orthopaedic Trauma 2002;16(6):386-93. [PMID: ] - PubMed
    1. Saudan M, Lubecke A, Sadowski Ch, Riand N, Stern R, Hoffmeyer P.Is there an indication for intramedullary fixation of intertrochanteric fractures? [abstract]. In: European Federation of National Associations of Orthopaedics and Traumatology; 2001 Jun 1-7; Rhodes (Greece). 2001.
    1. Saudan M, Lubecke-Wolff A, Sadowski C, Riand N, Hoffmeyer P.The proximal femoral nail (PFN) and the dynamic hip screw (DHS): a prospective clinical trial [abstract]. Journal of Bone and Joint Surgery. British Volume 1999;81 Suppl 2:163.
    1. Stern RE, Sadowski C, Lubbeke A, Saudan M, Riand N, Hoffmeyer P.Pertrochanteric fractures: is there an advantage to an intramedullary nail? [abstract]. In: Annual Meeting of the Orthopaedic Trauma Association; 2001 Oct 18-20; San Diego (California). Orthopaedic Trauma Association, 2001.
Sharma 2018 {published data only}
    1. Sharma A, Sethi A, Sharma S.Treatment of stable intertrochanteric fractures of the femur with proximal femoral nail versus dynamic hip screw: a comparative study. Revista Brasileira de Ortopedia 2018;53(4):477-81. [PMID: ] - PMC - PubMed
Singh 2017 {published data only}
    1. Singh AK, Narsaria N, Arun GR, Srivastava V.Treatment of unstable trochanteric femur fractures: Proximal Femur Nail versus Proximal Femur Locking Compression Plate. American Journal of Orthopedics 2017;46(2):E116-23. [PMID: ] - PubMed
Singh 2019 {published data only}
    1. Singh NK, Sharma V, Trikha V, Gamanagatti S, Roy A, Balawat AS, et al.Is PFNA-II a better implant for stable intertrochanteric fractures in elderly population? A prospective randomized study. Journal of Clinical Orthopaedics and Trauma 2019;10:S71-6. [PMID: ] - PMC - PubMed
    1. Singh NK.A prospective randomized control study comparing functional and radiological outcome in elderly patients with type 31 a1 and a2 intertrochateric fractures treated by proximal femoral nail anti-rotation (pfna) vs dynamic hip screw (dhs). Ann Arbor All India Institute of Medical Sciences, New Delhi (India) 2016;11004638:117.
Song 2011 {published data only}
    1. Song W, Chen Y, Shen H, Yuan T, Zhang C, Zeng B.Biochemical markers comparison of dynamic hip screw and gamma nail implants in the treatment of stable intertrochanteric fracture: a prospective study of 60 patients. Journal of International Medical Research 2011;39(2):822-9. [PMID: ] - PubMed
Tao 2013 {published data only}
    1. Tao R, Lu Y, Xu H, Zhou ZY, Wang YH, Liu F.Internal fixation of intertrochanteric hip fractures: a clinical comparison of two implant designs. The Scientific World Journal 2013;2013:834825. [PMID: ] - PMC - PubMed
Utrilla 2005 {published data only}
    1. Utrilla AL, Reig JS, Munoz FM, Tufanisco CB.Trochanteric Gamma nail and compression hip screw for trochanteric fractures: a randomized, prospective, comparative study in 210 elderly patients with a new design of the Gamma nail. Journal of Orthopaedic Trauma 2005;19(4):229-33. [PMID: ] - PubMed
Varela‐Egocheaga 2009 {published data only}
    1. Varela-Egocheaga JR, Iglesias-Colao R, Suarez-Suarez MA, Fernandez-Villan M, Gonzalez-Sastre V, Murcia-Mazon A.Minimally invasive osteosynthesis in stable trochanteric fractures: a comparative study between Gotfried percutaneous compression plate and Gamma 3 intramedullary nail. Archives of Orthopaedic and Trauma Surgery 2009;129(10):1401-7. [PMID: ] - PubMed
Verettas 2010 {published data only}
    1. Verettas D-AJ, Ifantidis P, Chatzipapas CN, Drosos GI, Xarchas KC, Chloropoulou P, et al.Systematic effects of surgical treatment on hip fractures: gliding screw-plating vs intramedullary nailing. Injury 2010;41(3):279-84. [PMID: ] - PubMed
    1. Verettas DAJ.personal communication 25 May 2010.
Wang 2019 {published data only}
    1. Wang B, Liu Q, Liu Y, Jiang R.Comparison of proximal femoral nail antirotation and dynamic hip screw internal fixation on serum markers in elderly patients with intertrochanteric fractures. Journal of the College of Physicians and Surgeons Pakistan 2019;29(7):644-8. [PMID: ] - PubMed
Xu 2010 {published data only}
    1. Xu YZ, Geng DC, Mao HQ, Zhu XS, Yang HL.A comparison of the proximal femoral nail antirotation device and dynamic hip screw in the treatment of unstable pertrochanteric fracture. The Journal of International Medical Research 2010;38:1266-75. [PMID: ] - PubMed
Xu 2018 {published data only}
    1. Xu R, Ru J, Ji F, Liu J, Ji Y, Wu Z, et al.Comparison of efficacy, complications and TGF-beta2 expression between DHS and PFNA in elderly patients with osteoporotic femoral intertrochanteric fracture. Experimental and Therapeutic Medicine 2018;16(1):394-9. [PMID: ] - PMC - PubMed
Yamauchi 2014 {published data only}
    1. Yamauchi K, Fushimi K, Shirai G, Fukuta M.Comparison of functional recovery in the very early period after surgery between plate and nail fixation for correction of stable femoral intertrochanteric fractures: a controlled clinical trial of 18 patients. Geriatric Orthopaedic Surgery & Rehabilitation 2014;5(2):63-8. [PMID: ] - PMC - PubMed
Zehir 2015 {published data only}
    1. Zehir S, Zehir R, Azboy I, Haykir N.Proximal femoral nail antirotation against dynamic hip screw for unstable trochanteric fractures; a prospective randomized comparison. European Journal of Trauma & Emergency Surgery 2015;41(4):393-400. [PMID: ] - PubMed
Zhou 2012 {published data only}
    1. Zhou F, Zhang Z, Yang H, Tian Y, Ji HQ, Guo Y, et al.Less invasive stabilization system (LISS) versus Proximal Femoral Nail Anti-rotation (PFNA) in treating proximal femoral fractures: a prospective randomized study. Journal of Orthopaedic Trauma 2012;26(3):155-62. [PMID: ] - PubMed
Zou 2009 {published data only}
    1. Zou J, Xu Y, Yang H.A comparison of proximal femoral nail antirotation and dynamic hip screw devices in trochanteric fractures. Journal of International Medical Research 2009;37(4):1057-64. [PMID: ] - PubMed

References to studies excluded from this review

ACTRN12608000162314 {published and unpublished data}
    1. ACTRN12608000162314.Prospective randomised pilot study comparing the dynamic hip screw and intramedullary gamma nail regarding the treatment of intertrochanteric hip fracture [Prospective randomised pilot study comparing the dynamic hip screw and intramedullary gamma nail regarding functional recovery following the treatment of intertrochanteric hip fractures]. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=82348 (first received 1 August 2008).
    1. Molnar R.Trial status [personal communication]. Email to: R Macey 3 August 2015.
Ahmad 2011 {unpublished data only}
    1. Ahmad M, Bajwa A, Patil S, Bhattacharya R, Nanda R, Danjoux G, et al.Haemodynamic changes during fixation of extracapsular proximal femoral fractures: RCT comparing compression hip screw versus intramedullary hip screw [abstract]. Journal of Bone and Joint Surgery. British Volume 2011;93(Suppl III):313-4.
    1. Ahmad M, Bhattacharya R, Nanda R, Bajwa A, Danjoux G, Hui AC.An RCT comparing haemodynamic changes during the fixation of extracapsular proximal femoral fractures using the compression hip screw versus the intramedullary hip screw [abstract]. The Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland 2005;3(Suppl 3):S10.
    1. Ahmad M.Randomised controlled trial to compare the magnitude and incidence of haemodynamic changes during fixation of extracapsular fractures of the neck of femur using the compression hip screw versus the intramedullary hip screw. National Research Register Archive. nihr.ac.uk/Profiles/NRR.aspx?Publication_ID=N0227149002 (accessed 7 June 2010).
Gupta 2012 {published data only}
    1. Gupta A, Cooke C, Wilkinson M, Grazette A.Randomised control trial comparing long cephlocondylic nail vs compression hip screw for treatment of intertrochanteric hip fractures (abstract). Journal of Bone and Joint Surgery. British Volume 2012;94(Suppl XLI):117.
Lee 2007 {published data only}
    1. Lee P-C, Hsieh P-H, Yu S-W, ShIao C-W, Kao H-K, Wu C-C.Biologic plating versus intramedullary nailing for comminuted subtrochanteric fractures in young adults: a prospective, randomised study of 66 cases. Journal of Trauma-Injury Infection & Critical Care 2007;63(6):1283-91. [PMID: ] - PubMed
NCT00686023 {published data only}
    1. NCT00686023.Comparing Surgical Techniques for CRIF of Pertrochanteric Fractures. clinicaltrials.gov/ct2/show/NCT00686023 (first received 29 May 2008).
NCT00736684 {published data only}
    1. NCT00736684.Proximal Femoral Nail Antirotation™ (PFNA) versus Gamma Nail 3™ (Gamma3) for intramedullary nailing of unstable trochanteric fractures (PROGAINT-ES). clinicaltrials.gov/ct2/show/NCT00736684 (first received 18 August 2008).
NCT01173744 {published data only}
    1. NCT01173744.Comparison of Gamma nail versus Dynamic Hip Screw for the treatment of unstable intertrochanteric fractures. clinicaltrials.gov/ct2/show/NCT01173744 (first received 2 August 2010).
NCT01238068 {unpublished data only}
    1. NCT01238068.Comparison of the results of treatment by Gamma nail versus dynamic hip screw for unstable intertrochanteric hip fractures. clinicaltrials.gov/show/NCT01238068 (first received 10 November 2010).
NCT03065101 {published data only}
    1. NCT03065101.Trigen InterTAN vs Sliding Hip Screw RCT. clinicaltrials.gov/ct2/show/NCT03065101 (first received 27 February 2017).
Stern 2011 {published data only}
    1. Stern R, Lübbeke A, Suva D, Miozzari H, Hoffmeyer P.Prospective randomised study comparing screw versus helical blade in the treatment of low-energy trochanteric fractures. International Orthopaedics 2011;35(12):1855-61. [PMID: ] - PMC - PubMed

References to studies awaiting assessment

NCT01380444 {unpublished data only}
    1. NCT01380444.Intramedullary nail versus sliding hip screw inter-trochanteric evaluation (INSITE). clinicaltrials.gov/show/NCT01380444 (first received 27 June 2011).
    1. Schemitsch EH.Intramedullary nailing versus sliding hip screw intertrochanteric evaluation: the INSITE Trial. In: Orthopaedic Trauma Association Annual Meeting; 2020 Oct 21-24; virtual meeting. ota.org/sites/files/abstracts/2020/OTA AM20 Paper Schemitsch.pdf, 2021.
NCT02788994 {published data only}
    1. NCT02788994.Stabilization of fresh unilateral unstable pertrochanteric hip fracture (PET). clinicaltrials.gov/show/NCT02788994 (first received 2 June 2016).
NCT03849014 {published data only}
    1. NCT03849014.Comparison of biochemical changes in patients with trochanteric region fracture fixation with DHS versus PFN. clinicaltrials.gov/show/NCT03849014 (first received 21 February 2019).
REGAIN 2008 {published data only}
    1. Bhandari M, Bojan A, Eckholm C, Brink O, Adili A, Sprague S, et al.Functional outcomes following intramedullary nailing of trochanteric hip fractures: a pilot multicentre, randomised controlled trial (abstract). Journal of Bone and Joint Surgery. British Volume 2011;93 Suppl IV:574.
    1. NCT00555945.Re-evaluation of Gamma3 intramedullary nails in hip fracture (REGAIN). clinicaltrials.gov/ct2/show/NCT00555945 (first received 9 November 2007).

References to ongoing studies

IRCT20141209020258N80 {published data only}
    1. IRCT20141209020258N80.Comparison proximal femoral nailing (PFN) versus dynamic hip screw(DHS) in intertrochanteric fracture. en.irct.ir/trial/31176 (first received 11 June 2018).
NCT03906032 {published data only}
    1. NCT03906032.Comparison of sliding hip screw to intra medullary nailing in the treatment of intertrochanteric hip fracture. clinicaltrials.gov/ct2/show/NCT03906032 (first received 8 April 2019).

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References to other published versions of this review

Parker 1996
    1. Parker MJ, Handoll HHG, Robinson CM.Gamma nail versus sliding hip screw for the treatment of extracapsular femoral fractures. Cochrane Database of Systematic Reviews 1996, Issue 3.
Parker 1996a
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Parker 1999
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Parker 2002a
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Parker 2002b
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Parker 2004
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Publication types

Associated data