Abstract
Background Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw
versus cancellous screws on the risk of reoperation and other key outcomes.
Methods For this international, multicentre, allocation concealed randomised controlled trial, we enrolled patients
aged 50 years or older with a low-energy hip fracture requiring fracture fixation from 81 clinical centres in eight countries.
Patients were assigned by minimisation with a centralised computer system to receive a single large-diameter screw
with a side-plate (sliding hip screw) or the present standard of care, multiple small-diameter cancellous screws.
Surgeons and patients were not blinded but the data analyst, while doing the analyses, remained blinded to treatment
groups. The primary outcome was hip reoperation within 24 months after initial surgery to promote fracture healing,
relieve pain, treat infection, or improve function. Analyses followed the intention-to-treat principle. This study was
registered with ClinicalTrials.gov, number NCT00761813.
Findings Between March 3, 2008, and March 31, 2014, we randomly assigned 1108 patients to receive a sliding hip
screw (n=557) or cancellous screws (n=551). Reoperations within 24 months did not differ by type of surgical fixation
in those included in the primary analysis: 107 (20%) of 542 patients in the sliding hip screw group versus 117 (22%)
of 537 patients in the cancellous screws group (hazard ratio [HR] 0·83, 95% CI 0·63–1·09; p=0·18). Avascular
necrosis was more common in the sliding hip screw group than in the cancellous screws group (50 patients [9%] vs
28 patients [5%]; HR 1·91, 1·06–3·44; p=0·0319). However, no significant difference was found between the number
of medically related adverse events between groups (p=0·82; appendix); these events included pulmonary embolism
(two patients [Interpretation In terms of reoperation rates the sliding hip screw shows no advantage, but some groups of patients
(smokers and those with displaced or base of neck fractures) might do better with a sliding hip screw than with
cancellous screws.
versus cancellous screws on the risk of reoperation and other key outcomes.
Methods For this international, multicentre, allocation concealed randomised controlled trial, we enrolled patients
aged 50 years or older with a low-energy hip fracture requiring fracture fixation from 81 clinical centres in eight countries.
Patients were assigned by minimisation with a centralised computer system to receive a single large-diameter screw
with a side-plate (sliding hip screw) or the present standard of care, multiple small-diameter cancellous screws.
Surgeons and patients were not blinded but the data analyst, while doing the analyses, remained blinded to treatment
groups. The primary outcome was hip reoperation within 24 months after initial surgery to promote fracture healing,
relieve pain, treat infection, or improve function. Analyses followed the intention-to-treat principle. This study was
registered with ClinicalTrials.gov, number NCT00761813.
Findings Between March 3, 2008, and March 31, 2014, we randomly assigned 1108 patients to receive a sliding hip
screw (n=557) or cancellous screws (n=551). Reoperations within 24 months did not differ by type of surgical fixation
in those included in the primary analysis: 107 (20%) of 542 patients in the sliding hip screw group versus 117 (22%)
of 537 patients in the cancellous screws group (hazard ratio [HR] 0·83, 95% CI 0·63–1·09; p=0·18). Avascular
necrosis was more common in the sliding hip screw group than in the cancellous screws group (50 patients [9%] vs
28 patients [5%]; HR 1·91, 1·06–3·44; p=0·0319). However, no significant difference was found between the number
of medically related adverse events between groups (p=0·82; appendix); these events included pulmonary embolism
(two patients [Interpretation In terms of reoperation rates the sliding hip screw shows no advantage, but some groups of patients
(smokers and those with displaced or base of neck fractures) might do better with a sliding hip screw than with
cancellous screws.
| Original language | English |
|---|---|
| Pages (from-to) | 1519-1527 |
| Number of pages | 9 |
| Journal | The Lancet |
| Volume | 389 |
| Publication status | Published - 2 Mar 2017 |