Last updated on February 2009

Evaluation of Surgical Fixation Using Alternative Implants for the Treatment of Hip Fractures

Brief description of study

The primary purpose of this study is to assess the impact of sliding hip screws versus cannulated screw fixation on rates of revision surgery at 2 years in individuals over 50 years of age with femoral neck fractures. The secondary objective of the study is to determine the impact of sliding hip screws versus cannulated screw fixation on health-related quality of life, functional outcomes and generic utility measures.

Detailed Study Description

Hip fractures occur in 280,000 Americans (over 5,000 per week) and 36,000 (over 690 per week) Canadians annually. The number of hip fractures is likely to exceed 500,000 annually in the United States and 88,000 in Canada. The estimated annual health care costs will reach a staggering $9.8 billion in the United States and $650 million in Canada. Hip fractures are associated with a 30% mortality rate and profound temporary and sometimes permanent impairment of independence and quality of life. Worldwide, 4.5 million persons are disabled from hip fractures yearly with an expected increase to 21 million persons living with disability in the next 40 years. Experimental data suggest that cancellous screws offer greater preservation of blood supply, while sliding hip screws provide greater biomechanical stability to bending stresses. While both arguments are persuasive, the impacts of these biologic alterations on outcomes that are important to patients offer more compelling guidance for clinical practice. Although current opinion among orthopaedic surgeons favour the use of cancellous screws over sliding hip screws, there remains sufficient divergence in perceptions and sufficient interest to resolve this issue to warrant a large randomized controlled trial. Despite the popularity of cancellous screw fixation, there is a strong biologic rationale supporting the sliding hip screws, a more biomechanically stable construct, in older patients with osteopenia or osteoporosis. While our meta-analysis provides indirect and direct evidence that a sliding hip screw may reduce revision surgery rates, the evidence remains far from definitive. The current best estimate of treatment effect with sliding hip screws is based upon small trials with methodological limitations including unconcealed randomization and lack of blinding. The resulting estimates include wide confidence intervals (i.e., displaced fractures: RRR=27%, 95%CI: 48%, -4%, P=0.08). Whatever approach to internal fixation proves best, a large proportion of patients will continue to need revision surgery that is associated with high morbidity and appreciable mortality

Clinical Study Identifier: NCT00557167

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Erasmus Medical Center

Rotterdam, Netherlands
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