Hip fractures located outside the hip joint capsule (extracapsular hip fractures) may be surgically fixed using metal implants. Often these are extramedullary devices consisting of a screw or rod, inserted in the upper part of the thigh bone (femur) to bridge (fix) the fracture, connected to a plate secured to the femur. Sometimes external fixators are used. In these, the stabilising component is held outside the thigh by pins or screws driven into the bone on either side of the fracture.
The 14 randomised controlled trials included in this review tested seven comparisons in a total of 2222 mainly female and older participants. All trials had methodological flaws that may affect the validity of their results and there was a general lack of evidence on long-term effects and functional recovery. Some extramedullary implants appeared to be associated with an increased risk of fixation complications and reoperation. In particular, three trials comparing a fixed nail plate (Jewett or McLaughlin) with the sliding hip screw (the 'standard' extramedullary device for these fractures) found an increased risk of fixation failure for fixed nail plates. Less invasive implants, such as the external fixator, which require smaller incisions resulted in less blood loss and often quicker operations than the sliding hip screw.
We concluded that the sliding hip screw seems preferable to older types of fixed nail plates given their high rate of implant and fixation failure. However, there was not enough evidence to draw conclusions for other comparisons of extramedullary implants or on the use of external fixators.