A Cochrane review [Abstract] 1 included 9 studies with a total of 1 290 predominantly female and older subjects with mainly unstable trochanteric fractures. Four studies, with 910 participants, compared the proximal femoral nail with the Gamma nail. Though there was increased risk of comminution (fragmentation) at the fracture site when inserting a Gamma nail, there was no statistically significant difference in operative fracture of the femur (1/455 versus 5/455; RR 0.33, 95% CI 0.07 to 1.63). No notable differences were seen between implants for fracture healing complications, reoperations and other post-operative complications. Pooled data showed no significant difference between implants for mortality (RR 1.08, 95% CI 0.82 to 1.41) or function assessment outcomes. Two studies (185 participants) found no notable differences between the ACE nail versus the Gamma nail. One study (34 participants, all under 50 years) found no difference between the Recon nail versus the long Gamma nail. One study, with 80 participants, found no differences between a gliding nail versus a standard Gamma nail. Another study, with 81 participants, found no difference between a dynamically versus a statically locked intramedullary hip screw.
Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison) and by limitations in study quality (inadequate intention-to-treat adherence, inadequate or unclear method of randomization and allocation concealment).
Primary/Secondary Keywords