BACKGROUND: Extramedullary fixation of @entity173 refers to the application of a plate and screws to the lateral side of the proximal femur. OBJECTIVES: To compare different types of extramedullary fixation implants for the surgical treatment of extracapsular hip @entity174 in adults. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group specialised register and reference lists of relevant articles. Date of the most recent search: October 2001. SELECTION CRITERIA: All randomised or quasi-randomised trials comparing extramedullary implants used in 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 all trialists. Wherever appropriate and possible, data from comparable trials were pooled. MAIN RESULTS: Two new trials investigating the Medoff plate are included in this update. All ten included trials (involving 1856 @entity1 ) had methodological flaws which may have resulted in serious bias. Three trials involving 355 @entity1 compared a fixed nail plate (Jewett or McLaughlin) with the @entity572 ( @entity572 ). The limited data presented indicated an increased risk of fixation failure outcomes for fixed nail plates. The two trials, involving 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 involving 100 @entity1 compared the Pugh nail and the @entity572 . There was no significant difference between implants for the outcome measures reported. Two trials involving 292 @entity1 with 296 @entity174 , compared the Medoff plate with the @entity572 . Higher mean operative @entity190 and longer mean operative time were reported for the Medoff plate in one trial. There was a lower risk of fixation failure for unstable @entity173 fixed with the Medoff plate. Two trials involving, respectively, 569 @entity1 with unstable @entity173 and 107 with subtrochanteric @entity174 compared the Medoff plate with three different screw-plate systems. There were no statistically significant differences in outcome for @entity173 . For subtrochanteric @entity174 , there was a tendency to a lower fixation failure rate for the Medoff plate, but no evidence for differences in longer-term outcomes. 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 the clinical significance of differences between the @entity572 and either the RAB plate, the Pugh nail or the Medoff plate.

Extramedullary fixation implants for extracapsular XXXX .

@entity1 :: ('9606', 'Species') :: ['participants', 'patients'] @entity174 :: ('MESH:D050723', 'Disease') :: ['fractures', 'fracture'] @entity190 :: ('MESH:D006473', 'Disease') :: ['blood loss'] @entity173 :: ('MESH:D006620', 'Disease') :: ['trochanteric fractures', 'hip fractures'] @entity572 :: ('MESH:D006617', 'Disease') :: ['SHS', 'sliding hip screw']
@entity173 :: (MESH:D006620,Disease) :: ['hip fractures']
