Cochrane Summaries

Trusted evidence. Informed decisions. Better health.

Intramedullary nails for extracapsular hip fractures in adults

Parker MJ, Handoll HHG
Published Online: 
8 October 2008

Fractures of the upper part of the thigh bone (femur) are termed hip or proximal femoral fractures. Roughly half of all hip fractures are 'extracapsular' in that they lie outside the hip joint capsule. These fractures may be surgically fixed using metal implants. One type of implant is the 'intramedullary nail'. This consists of a metal rod, which is usually inserted from the upper end of the femur into the inner cavity (medulla) of the femur bone and held in place with screws.

This review assessed the evidence from nine randomised controlled trials that compared different designs of these nails. Four trials compared the proximal femoral nail with the Gamma nail in 910 older adults. Two trials involving 185 older adults compared the ACE intramedullary nail with the Gamma nail. One trial compared the Recon nail with the Gamma nail in 34 younger adults, all under 51 years old, with high-energy fractures such as from road traffic accidents. For all three comparisons there appeared to be no important differences in outcome between the two nails under test. One trial of 80 older adults looked at the effects of changing the design of one of the screws, and another trial of 81 older adults looked at the effects of changing one of the interlocking holes. Both these studies had too few participants to see if these changes in nail design had an important effect.

So far, the limited evidence from randomised controlled trials has not shown any important differences between the different designs of nails under test.