Fit healthy 25yo male with no pain. CC was change in gait. | Figure 1

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Fit healthy 25yo male with no pain. CC was change in gait.

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Key messages

• There is no 'best treatment' for this type of broken hip.
• More people needed additional surgery on their broken hip after treatment with condylocephalic nails or static fixed angle plates.
• There may be no difference between a short cephalomedullary nail and a dynamic fixed angle plate.
• We found too few studies to know whether any of these treatments were better at improving quality of life.

We searched for studies that compared one or more of these treatments:

• Using metal implants to fix the broken parts of the bone. These long or short nails may be inserted downwards from the hip joint towards the knee (cephalomedullary nails). Some nails may be inserted upwards from the knee towards the hip joint (condylocephalic nail). Alternatively, the surgeon may use a 'fixed angle plate' which sits on the outer edge of the broken bone and is attached to the bone with screws or pins.
• Replacing the broken hip with an artificial one. This can be done using a hemiarthroplasty (HA), which replaces only the ball part of the joint, or with a total hip arthroplasty (THA) which replaces all of the hip joint including the socket.
• Using external fixation. Pins or screws are placed into the bones around the fracture and a metal frame holds these nails in place.
• Treatment without an operation, usually requiring a period of rest in bed whilst the leg is held in position using traction with weights.

We found 184 studies with 26,073 people with this type of hip fracture. We included 73 of these studies in a network meta-analysis.

We found little or no difference in how many people died with each treatment. We were unsure whether any of the treatments were better than another at reducing deaths within 12 months of surgery.

For most treatments, we also found little or no difference in whether people needed to have additional surgery on their broken hip. However, for the condylocephalic nail and the static fixed angle plate, more people needed additional surgery compared to people treated with a dynamic fixed angle plate. These treatments may increase the chance of needing additional surgery.