The clinical evidence behind the current implants used for proximal femoral fractures is weak considering the number of implants used worldwide .
Sporadic evaluation is not sufficient to identify long term problems .
INTRODUCTION Evaluation of the long-term performance of  implants used in trauma surgery relies on post-marked clinical studies since no registry based implant assessment exists .
The purpose of this study was to evaluate the evidence of performance of implants  currently used for treating proximal femoral fractures ( PFF ) in Denmark .
A prospective trial comparing the Holland nail with the dynamic hip screw in the treatment of intertrochanteric fractures of the hip.
We compared the outcome of patients treated for an intertrochanteric fracture of the femoral neck with a locked  , long intramedullary nail with those treated with a dynamic hip screw ( DHS )  in a prospect i ve r and omised study . Each patient who presented with an extra-capsular hip fracture was r and omised to operative stabilisation with either a long intramedullary Holl and nail or a DHS . We treated 92 patients with a Holl and nail and 98 with a DHS .  Pre-operative variables included the Mini Mental test score , patient mobility , fracture pattern and American Society of Anesthesiologists grading . Peri-operative variables were anaesthetic time , operating time , radiation time and blood loss . Post-operative variables were time to mobilising with a frame , wound infection , time to discharge , time to fracture union , and mortality . We found no significant difference in the pre-operative variables . The mean anaesthetic and operation times were shorter in the DHS group than in the Holl and nail group ( 29.7 vs 40.4 minutes , p < 0.001 ; and 40.3 vs 54 minutes , p < 0.001 , respectively ) . There was an increased mean blood loss within the DHS group versus the Holl and nail group ( 160 ml vs 78 ml , respectively , p < 0.001 ) . The mean time to mobilisation with a frame was shorter in the Holl and nail group ( DHS 4.3 days , Holl and nail 3.6 days , p = 0.012 ) . More patients needed a post-operative blood transfusion in the DHS group ( 23 vs seven , p = 0.003 ) and the mean radiation time was shorter in this group ( DHS 0.9 minutes vs Holl and nail 1.56 minutes , p < 0.001 ) . The screw of the DHS cut out in two patients , one of whom underwent revision to a Holl and nail . There were no revisions in the Holl and nail group . All fractures in both groups were united when followed up after one year . We conclude that the DHS can be implanted more quickly and with less exposure to radiation than the Holl and nail . However , the result ant blood loss and need for transfusion is greater . The Holl and nail allows patients to mobilise faster and to a greater extent . We have therefore adopted the Holl and nail as our preferred method of treating intertrochanteric fractures of the hip
The clinical evidence behind the current implants used for proximal femoral fractures is weak considering the number of implants used worldwide .
Sporadic evaluation is not sufficient to identify long term problems .
INTRODUCTION Evaluation of the long-term performance of  implants used in trauma surgery relies on post-marked clinical studies since no registry based implant assessment exists .
The purpose of this study was to evaluate the evidence of performance of implants  currently used for treating proximal femoral fractures ( PFF ) in Denmark .