Fixed nail plates versus sliding hip systems for the treatment of trochanteric femoral fractures: a meta analysis of 14 studies.

In order to compare accurately fixed nail plates with sliding implants 13 randomised, quasi-randomised or comparative studies, involving a total of 2,855 patients, which compared these implants, were systematically reviewed. In addition the results of a further 214 patients treated in a prospective audit are presented. Results showed an increased risk of cut-out (13% versus 4%), non-union (2% versus 0.5%), implant breakage (14% versus 0.7%) and re-operation (10% versus 4%) for fixed nail plates in comparison with the sliding implants. In addition patients treated with fixed nail plates had a higher mortality and the survivors were more likely to have residual pain in the hip and impaired mobility. The continued use of fixed nail plates cannot be justified given the unequivocal superiority of the sliding hip screw.