Extramedullary fixation implants and external fixators for extracapsular XXXX .

@entity1 @entity174 @entity190 @entity173 @entity572 @entity130
BACKGROUND: Extramedullary fixation of @entity173 involves the application of a plate and screws to the lateral side of the proximal femur. In external fixators, the stabilising component is held outside the thigh by pins or screws driven into the bone on either side of the @entity174 . OBJECTIVES: To compare different types of extramedullary fixation implants and external fixators for treating extracapsular hip @entity174 in adults. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group specialised register and reference lists of relevant articles up to July 2002. SELECTION CRITERIA: All randomised or quasi-randomised trials comparing these devices for the fixation of extracapsular hip @entity174 in adults. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality, using a ten item scale, and extracted data. Additional information was sought from trialists when required. Wherever appropriate, data from comparable trials were pooled. MAIN RESULTS: Two trials examining the Gotfried plate and one, an external fixator, are newly included in this update. All 13 included trials had methodological flaws, which may affect the validity of their results. The limited data available for three trials (355 @entity1 ) comparing a fixed nail plate (Jewett or McLaughlin) with the @entity572 ( @entity572 ) indicated an increased risk of fixation failure for fixed nail plates. The two trials (433 @entity1 ) comparing the RAB plate with the @entity572 had contrasting results, notably in terms of operative complications, fixation failure and anatomical restoration. One trial (100 @entity1 ) found no significant difference between the Pugh nail and the @entity572 . Two trials (292 @entity1 ) compared the Medoff plate with the @entity572 . One trial reported higher operative @entity190 and longer operative times for the Medoff plate. There was a lower risk of fixation failure for unstable @entity173 fixed with the Medoff plate. Two trials involving, respectively, unstable @entity173 (569 @entity1 ) and @entity173 (107 @entity1 ) compared the Medoff plate with three different screw-plate systems. There were no statistically significant differences in outcome for @entity173 . For @entity173 , there was a tendency to less fixation failure for the Medoff plate, but no evidence for differences in longer-term outcomes. Two trials (226 @entity1 ) compared the Gotfried percutaneous plate with a @entity572 . A higher intra-operative fixation failure rate of the Gotfried plate indicated some specific restriction to its use. The Gotfried plate appeared to involve lower operative blood losses. There were insufficient data on long term outcomes. One trial (100 @entity1 ) provided some evidence of less operative @entity130 and speedier recovery for external fixation when compared with the @entity572 . Final outcomes appeared similar. REVIEWER'S CONCLUSIONS: The fixed nail plate has higher risks of implant breakage and fixation failure than the @entity572 . Though insufficient evidence on other outcomes is available from randomised trials, the increased fixation failure rate is a major consideration and thus the @entity572 appears preferable. Insufficient information is available to draw firm conclusions of significant differences between the @entity572 and either the RAB, the Pugh, the Medoff or the Gotfried plates, or an external fixator.
