The purpose of this meta-analysis was to compare the fixation outcome between the sliding hip screw (SHS) and intramedullary nails (IMN) in stable and unstable extracapsular proximal femoral fractures. with the IMN compared with the SHS. There was no evidence for a reduced failure rate with IMN in unstable trochanteric fractures. Rsum Le but de cette mta-analyse tait de comparer le rsultat de la fixation par vis glissante et clou centromdullaire dans les fractures extracapsulaires fmorales proximales stables et instables. Toutes les tudes randomises et contr?les qui comparent des clous centromdullaires avec une vis glissante ont t considres pour linclusion. Les donnes ont t extraites indpendamment, et la mthodologie de ltude tudie. 24 essais randomiss qui concernent 3,202 malades avec 3,279 fractures ont t inclus. CD79B Les rsultats mis en commun nont donn aucune diffrence statistiquement notable entre le clou centromdullaire et la vis glissante (41/1,556 vs 37/1,626; risque relatif 1.19; 95% intervalle de confidence 0.78C1.82). Le taux dchec total (103/1,495?vs 58/1,565, risque relatif 1.83; 95% intervalle de confiance 1.35C2.50) et tle aux de la r – opration (57/1,357 vs 35/1,415, risque relatif 1.63; 95% intervalle de confiance 1.11C2.40) taient plus grands avec le clou centromdullaire compar a la vis glissante. Il ny avait aucune preuve quil y ait un taux de dfaillance rduit avec le clou centromdullaire dans les fractures trochanterienne instables. Introduction Extracapsular hip fractures are increasingly common and most frequently occur in elderly patients. Operative TG003 supplier treatment of extracapsular hip fractures was introduced TG003 supplier in the TG003 supplier 1950s using a variety of different implants. The foremost implant used for internal fixation is the sliding hip screw device (SHS), of which there are various equivalent models, such as the Dynamic, Richards, or Ambi hip screws. These implants can be described as an extramedullary fixation implant. Their dynamic nature allows for collapse at the fracture site, and they have superseded the older, fixed nail plates, which did not allow for collapse at the fracture site. An alternative method of fixation of extracapsular hip fractures is an intramedullary nail (IMN). The early proximally inserted designs, such as the Kuntscher Y nail, did not allow for collapse at the fracture site. Within the last 20 years, a variety of newer, short IMN fixation devices that allow for sliding and therefore collapse at the fracture site have been introduced. The first of these to be commercially available was the gamma nail (Howmedica Ltd). Subsequently, the intramedullary hip screw (IMHS) (Richards Medical Ltd) was introduced in 1995 and the proximal femoral nail (PFN) (Synthes Ltd) in 1998. A theoretical advantage of intramedullary fixation is that it provides a more biomechanically stable construct by reducing the distance between the hip joint and the implant. Potential disadvantages are related to greater risk of jamming of the sliding mechanism and stress risers at the site of the tip of the nail and distal locking bolts. It has been suggested, without supporting clinical data, that the IMNs are superior for unstable trochanteric fractures, reverse oblique fractures and sub-trochanteric fractures [2, 3]. Controversy, therefore, continues regarding the optimum choice of implant for these unstable fractures [14]. Several randomised controlled trials of fixation of extracapsular hip fractures comparing an IMN device with the SHS have been performed. An early summation of the results of ten of these studies demonstrated an increased risk of fixation failure and re-operation for the intramedullary devices [17]. A number of further randomised trials have since been undertaken. This has enabled a more extensive meta-analysis of prospective randomised controlled trials of nails versus SHS devices TG003 supplier for the fixation of extracapsular hip fractures. In addition, it has now been possible to undertake a subgroup analysis for different fracture types. Methods We searched for relevant studies using the search strategy of the Cochrane collaboration. This included searching the Cochrane Musculoskeletal Injuries Group Trials Register, computer searching of MEDLINE, EMBASE, CINAHL and current contents, hand searching of orthopaedic journals, conference proceedings and reference.