A Cochrane review included 43 studies with predominantly older people with mainly trochanteric fractures.
The Gamma nail was associated with an increased risk of operative and later fracture of the femur and an increased reoperation rate as compared with the sliding hip screw (SHS; 22 trials, n=3 749). There were no major differences between implants in the wound infection, mortality or medical complications. Fracture fixation complications were more common also with the intramedullary hip screw (IMHS) as compared with the SHS (5 trials, n=623). Results for post-operative complications, mortality and functional outcomes were similar in the two groups. There were no differences in fracture fixation complications, reoperation, wound infection and length of hospital stay for proximal femoral nail (PFN) compared with the SHS (3 trials, n=394).
None of the 10 trials (n=1 491) of other nail versus extramedullary implant comparisons for trochanteric fractures provided sufficient evidence to establish definite differences between the implants under test. Two trials (n=65) found intramedullary nails were associated with fewer fracture fixation complications than fixed nail plates for unstable fractures at the level of the lesser trochanter. Two trials (n=124) found a tendency to less fracture healing complications with the intramedullary nails compared with fixed nail plates for subtrochanteric fractures.