Treatment of Common Hip Fractures [Entered Retrospectively]

Project Summary Title and Description

Title
Treatment of Common Hip Fractures [Entered Retrospectively]
Description
Objectives: To conduct a systematic review and synthesize the evidence for the effects of surgical treatments for subcapital and intertrochanteric/subtrochanteric hip fractures on patient-focused outcomes for elderly patients. Data Sources: MEDLINE®, Cochrane databases, Scirus, and ClinicalTrials.gov, and expert consultants. We also manually searched reference lists from relevant systematic reviews. Review Methods: High quality quasi-experimental design studies were used to examine relationships between patient characteristics, type of fracture, and patient outcomes. Randomized controlled trials were used to examine relationships between type of surgical treatment and patient outcomes. Patient mortality was examined with Forest plots. Narrative analysis was used for pain, quality of life (QoL), and functional outcomes due to inconsistently measured and reported outcomes. Results: Mortality does not appear to differ by device class, or by devices within a class. Nor, on the whole, do pain, functioning, and QoL. Some internal fixation devices may confer earlier return to functioning over others for some patients, but such gains are very short lived. Very limited results suggest that subcapital hip fracture patients with total hip replacements have improved patient outcomes over internal fixation, but it is unclear whether these results would continue to hold if the analyses included the full complement of relevant covariates. Age, gender, prefracture functioning, and cognitive impairment appear to be related to mortality and functional outcomes. Fracture type does not appear to be independently related to patient outcomes. Again, however, the observational literature does not include the full complement of potential covariates and it is uncertain if these results would hold. Conclusions: Several factors limit our ability to definitively answer the key questions posed in this study using the existing literature. Limited perspectives lead to incomplete sets of independent variables included in analyses. Specific populations are poorly defined and separated for comparative study. Fractures with widely varying biomechanical problems are often lumped together. Outcome variables are inconsistently measured and reported, making it very difficult to aggregate or even compare results. If future high quality trials continue to support the evidence that differences in devices are short term at best, within the first few weeks to few months of recovery, policy implications involve establishing the value of a shorter recovery relative to the cost of the new device. As the literature generally focuses on community dwelling elderly patients, more attention needs to be directed toward understanding implications of surgical treatment choices for the nursing home population.
Attribution
N/A
Authors of Report
N/A
Methodology description
The main search strategy included a list of terms intended to identify all research publications associated with two domains; intertrochanteric/subtrochanteric and subcapital hip fractures and types of implant interventions. We used key words relevant to the two domains as the search basis for all key questions. (The search strategies are provided in Appendix C). Comparison to MeSH headings found that all references identified with MeSH headings were subsumed in the keyword searches. We used a tested search filter designed to identify methodologically high quality randomized controlled trials.
PROSPERO
N/A
DOI
10.7301/Z0JW8BSG
Notes
The systematic review data of this published project was retrospectively imported into SRDR by the Brown EPC on behalf of the Minnesota EPC and the Agency for Healthcare Research and Quality (AHRQ). For access to the full report available on the AHRQ website, follow this link: http://www.ahrq.gov/research/findings/evidence-based-reports/hipfractp.html
Funding Source
This report was requested and funded by the Agenecy for Health Research and Quality (AHRQ).

Key Questions

1. Key Question 1 [For IT Studies] – What is the relationship between patient variables, the type of fracture and patient post-treatment outcomes, such as pain and functioning?
2. Key Question 2 [For IT Studies] – What is the relationship between the type of fracture and patient post-treatment outcomes?
3. Key Question 3 [For IT Studies] – What is the relationship between implant variables and patient post-treatment outcomes?
4. Key Question 4 [For IT Studies] – What is the relationship between the type of intervention and patient post-treatment outcomes?
5. Key Question 1 [For FN Studies] – What is the relationship between patient variables, the type of fracture and patient post-treatment outcomes, such as pain and functioning?
6. Key Question 2 [For FN Studies] – What is the relationship between the type of fracture and patient post-treatment outcomes?
7. Key Question 3 [For FN Studies] – What is the relationship between implant variables and patient post-treatment outcomes?
8. Key Question 4 [For FN Studies] – What is the relationship between the type of intervention and patient post-treatment outcomes?

Associated Extraction Forms

Associated Studies (each link opens a new tab)

TitleAuthorsYear
One and two femoral neck screws with intramedullary nails for unstable trochanteric fractures of femur in the elderly--randomised clinical trial.2007
Intramedullary fixation of intertrochanteric hip fractures: a comparison of two implant designs.2007
Functional outcome in treatment of unstable trochanteric and subtrochanteric fractures with the proximal femoral nail and the Medoff sliding plate.
A randomised comparison of AMBI, TGN and PFN for treatment of unstable trochanteric fractures.2005
Cementless calcar-replacement hemiarthroplasty compared with intramedullary fixation of unstable intertrochanteric fractures. A prospective, randomized study.2005
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.2005
Femoral shaft medialisation and neck-shaft angle in unstable pertrochanteric femoral fractures.2004
Unstable trochanteric fractures augmented with calcium phosphate cement. A prospective randomized study using radiostereometry to measure fracture stability.2004
HA-coated screws decrease the incidence of fixation failure in osteoporotic trochanteric fractures.2004
A prospective, randomised study comparing the percutaneous compression plate and the compression hip screw for the treatment of intertrochanteric fractures of the hip.2007
Resorbable cement for the augmentation of internally-fixed unstable trochanteric fractures. A prospective, randomised multicentre study.2005
Pertrochanteric femoral fractures treated with a dynamic hip screw or a proximal femoral nail. A randomised study comparing post-operative rehabilitation.
The standard Gamma nail or the Medoff sliding plate for unstable trochanteric and subtrochanteric fractures. A randomised, controlled trial.2005
Treatment of unstable trochanteric fractures. Randomised comparison of the gamma nail and the proximal femoral nail.2004
Slotted intramedullary hip screw nails reduce proximal mechanical unloading.2003
A comparative study of trochanteric fractures treated with the Gamma nail or the proximal femoral nail.2002
A randomized study of the compression hip screw and Gamma nail in 426 fractures.2002
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.2002
Percutaneous compression plating (PCCP) versus the dynamic hip screw for pertrochanteric hip fractures: preliminary results.2002
Treatment of reverse oblique and transverse intertrochanteric fractures with use of an intramedullary nail or a 95 degrees screw-plate: a prospective, randomized study.2002
Intramedullary hip screw versus sliding hip screw for unstable intertrochanteric femoral fractures in the elderly.2002
The Gotfried percutaneous compression plate compared with the conventional classic hip screw for the fixation of intertrochanteric fractures of the hip.2002
The Gotfried PerCutaneous Compression Plate versus the Dynamic Hip Screw in the treatment of pertrochanteric hip fractures: minimal invasive treatment reduces operative time and postoperative pain.2002
Prospective randomized comparison between a dynamic hip screw and a mini-invasive static nail in fractures of the trochanteric area: preliminary results.
Prospective randomized controlled trial of an intramedullary nail versus dynamic screw and plate for intertrochanteric fractures of the femur.2001
Femoral shortening in intertrochanteric fractures. A comparison between the Medoff sliding plate and the compression hip screw.2001
Extramedullary fixation of 569 unstable intertrochanteric fractures: a randomized multicenter trial of the Medoff sliding plate versus three other screw-plate systems.2001
Prospective randomized comparison of gliding nail and gamma nail in the therapy of trochanteric fractures.1999
Extramedullary fixation of 107 subtrochanteric fractures: a randomized multicenter trial of the Medoff sliding plate versus 3 other screw-plate systems.1999
Treatment of intertrochanteric fracture with the Gamma AP locking nail or by a compression hip screw--a randomised prospective trial.1998
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.1998
Intramedullary versus extramedullary fixation for the treatment of intertrochanteric hip fractures.
Comparison of the compression hip screw with the Medoff sliding plate for intertrochanteric fractures.
Intertrochanteric fractures of the femur: a randomized prospective comparison of the Gamma nail and the Ambi hip screw.1996
Comparison of dynamic hip screw and gamma nail: a prospective, randomized, controlled trial.1995
Fixation of intertrochanteric hip fractures: gamma nail versus dynamic hip screw. A randomized, prospective study.1995
Treatment of unstable peritrochanteric fractures in elderly patients with a compression hip screw or with the Vandeputte (VDP) endoprosthesis: a prospective randomized study.1995
A prospective comparative study of the compression hip screw and the gamma nail.1994
Gamma nail vs compression screw for trochanteric femoral fractures. 15 reoperations in a prospective, randomized study of 378 patients.1994
Locking and compression of the lag screw in trochanteric fractures is not beneficial. A prospective, randomized study of 153 cases.1994
A prospective randomised comparison of the dynamic hip screw and the gamma locking nail.1993
Gamma nails and dynamic hip screws for peritrochanteric fractures. A randomised prospective study in elderly patients.1992
Fixation of intertrochanteric fractures of the femur. A randomised prospective comparison of the gamma nail and the dynamic hip screw.
Total hip arthroplasty and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck. A randomized, controlled trial.2006
A randomised study in all cervical hip fractures osteosynthesis with Hansson hook-pins versus AO-screws in 199 consecutive patients followed for two years.2006
Calcium phosphate cement for augmentation did not improve results after internal fixation of displaced femoral neck fractures: a randomized study of 118 patients.2006
The total costs of a displaced femoral neck fracture: comparison of internal fixation and total hip replacement. A randomised study of 146 hips.2006
Randomized comparison of reduction and fixation, bipolar hemiarthroplasty, and total hip arthroplasty. Treatment of displaced intracapsular hip fractures in healthy older patients.2006
Displaced intracapsular hip fractures in fit, older people: a randomised comparison of reduction and fixation, bipolar hemiarthroplasty and total hip arthroplasty.2005
Comparison of internal fixation with total hip replacement for displaced femoral neck fractures. Randomized, controlled trial performed at four years.2005
Comparison of outcomes following uncemented hemiarthroplasty and dynamic hip screw in the treatment of displaced subcapital hip fractures in patients aged greater than 70 years.2005
A randomised controlled trial comparing bipolar hemiarthroplasty with total hip replacement for displaced intracapsular fractures of the femoral neck in elderly patients.2007
Internal fixation versus hemiarthroplasty for displaced fractures of the femoral neck in elderly patients with severe cognitive impairment.2005
Unipolar or bipolar prosthesis for displaced intracapsular hip fracture in octogenarians: a randomised prospective study.1996
Stability of internally fixed femoral neck fractures augmented with resorbable cement. A prospective randomized study using radiostereometry.2003
Unipolar or bipolar hemiarthroplasty for femoral neck fractures in the elderly?2003
Costs of internal fixation and arthroplasty for displaced femoral neck fractures: a randomized study of 68 patients.2003
Fixation of fractures of the femoral neck. A prospective, randomised trial of three Ullevaal hip screws versus two Hansson hook-pins.
Internal fixation compared with total hip replacement for displaced femoral neck fractures in the elderly. A randomised, controlled trial.2003
Treatment of displaced femoral neck fractures: a randomized minimum 5-year follow-up study of screws and bipolar hemiprostheses in 100 patients.2003
Hemiarthroplasty versus internal fixation for displaced intracapsular hip fractures in the elderly. A randomised trial of 455 patients.2002
A prospective randomised trial of internal fixation versus arthroplasty for displaced fractures of the neck of the femur. Functional outcome for 450 patients at two years.2002
Thompson hemiarthroplasty is superior to Ullevaal screws in treating displaced femoral neck fractures in patients over 75 years. A prospective randomized study with two-year follow-up.2001
Heterotopic ossification following internal fixation or arthroplasty for displaced femoral neck fractures: a prospective randomized study.
Treatment for displaced intracapsular fracture of the proximal femur. A prospective, randomised trial in patients aged 65 to 79 years.2001
Internal fixation or arthroplasty for displaced cervical hip fractures in the elderly: a randomised controlled trial of 208 patients.2000
Internal fixation versus total hip arthroplasty in the treatment of displaced femoral neck fractures: a prospective randomized study of 100 hips.2000
Nutritional status and functional capacity after femoral neck fractures: a prospective randomized one-year follow-up study.2000
Internal fixation versus hemiarthroplasty versus total hip arthroplasty for displaced subcapital fractures of femur--13 year results of a prospective randomised study.2000
Cannulated screws versus hemiarthroplasty for displaced intracapsular femoral neck fractures in demented patients.2000
Cannulated screws for fixation of femoral neck fractures. No difference between Uppsala screws and Richards screws in a randomized prospective study of 268 cases.1998
Unipolar versus bipolar hemiarthroplasty for the treatment of femoral neck fractures in the elderly.1998
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.1997
Social function after cervical hip fracture. A comparison of hook-pins and total hip replacement in 47 patients.1996
Fixation of femoral neck fracture. A randomized 2-year follow-up study of hook pins and sliding screw plate in 222 patients.1995
Osteosynthesis versus endoprosthesis in the treatment of unstable intracapsular hip fractures in the elderly. A randomised clinical trial.1993
Use of a hydroxyapatite-coated hemiarthroplasty in the management of subcapital fractures of the femur.1993
Uppsala screws or Hansson pins for internal fixation of femoral neck fractures? A prospective study of 180 cases.1992
Bipolar hemiarthroplasty for subcapital fracture of the femoral neck. A prospective randomised trial of cemented Thompson and uncemented Moore stems.1991
Internal fixation of femoral neck fractures. Two methods compared.1991
Displaced subcapital fractures of the femur: a prospective randomized comparison of internal fixation, hemiarthroplasty and total hip replacement.1989
Fixation of femoral neck fractures. Comparison of the Uppsala and von Bahr screws.1989
Fixation of displaced femoral neck fractures. A comparison between sliding screw plate and four cancellous bone screws.1987
Avascular femoral head necrosis following fracture fixation.
Dislocated fractures of the femoral neck treated with von Bahr screws or hip compression screw. Results of a prospective, randomized study.-- Not Found --

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