Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial Journal Articles uri icon

  •  
  • Overview
  •  
  • Research
  •  
  • Identity
  •  
  • Additional Document Info
  •  
  • View All
  •  

abstract

  • BACKGROUND: Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes. METHODS: For this international, multicentre, allocation concealed randomised controlled trial, we enrolled patients aged 50 years or older with a low-energy hip fracture requiring fracture fixation from 81 clinical centres in eight countries. Patients were assigned by minimisation with a centralised computer system to receive a single large-diameter screw with a side-plate (sliding hip screw) or the present standard of care, multiple small-diameter cancellous screws. Surgeons and patients were not blinded but the data analyst, while doing the analyses, remained blinded to treatment groups. The primary outcome was hip reoperation within 24 months after initial surgery to promote fracture healing, relieve pain, treat infection, or improve function. Analyses followed the intention-to-treat principle. This study was registered with ClinicalTrials.gov, number NCT00761813. FINDINGS: Between March 3, 2008, and March 31, 2014, we randomly assigned 1108 patients to receive a sliding hip screw (n=557) or cancellous screws (n=551). Reoperations within 24 months did not differ by type of surgical fixation in those included in the primary analysis: 107 (20%) of 542 patients in the sliding hip screw group versus 117 (22%) of 537 patients in the cancellous screws group (hazard ratio [HR] 0·83, 95% CI 0·63-1·09; p=0·18). Avascular necrosis was more common in the sliding hip screw group than in the cancellous screws group (50 patients [9%] vs 28 patients [5%]; HR 1·91, 1·06-3·44; p=0·0319). However, no significant difference was found between the number of medically related adverse events between groups (p=0·82; appendix); these events included pulmonary embolism (two patients [<1%] vs four [1%] patients; p=0·41) and sepsis (seven [1%] vs six [1%]; p=0·79). INTERPRETATION: In terms of reoperation rates the sliding hip screw shows no advantage, but some groups of patients (smokers and those with displaced or base of neck fractures) might do better with a sliding hip screw than with cancellous screws. FUNDING: National Institutes of Health, Canadian Institutes of Health Research, Stichting NutsOhra, Netherlands Organisation for Health Research and Development, Physicians' Services Incorporated.

authors

  • Bhandari, Mohit
  • Nauth, Aaron
  • Creek, Aaron T
  • Zellar, Abby
  • Lawendy, Abdel-Rahman
  • Dowrick, Adam
  • Gupta, Ajay
  • Dadi, Akhil
  • van Kampen, Albert
  • Yee, Albert
  • de Vries, Alexander C
  • de Mol van Otterloo, Alexander
  • Garibaldi, Alisha
  • Liew, Allen
  • McIntyre, Allison W
  • Prasad, Amal Shankar
  • Romero, Amanda W
  • Rangan, Amar
  • Oatt, Amber
  • Sanghavi, Amir
  • Foley, Amy L
  • Karlsten, Anders
  • Dolenc, Andrea
  • Bucknill, Andrew
  • Chia, Andrew
  • Evans, Andrew
  • Gong, Andrew
  • Schmidt, Andrew H
  • Marcantonio, Andrew J
  • Jennings, Andrew
  • Ward, Angela
  • Khanna, Angshuman
  • Rai, Anil
  • Smits, Anke B
  • Horan, Annamarie D
  • Brekke, Anne Christine
  • Flynn, Annette
  • Duraikannan, Aravin
  • Stødle, Are
  • van Vugt, Arie B
  • Luther, Arlene
  • Zurcher, Arthur W
  • Jain, Arvind
  • Amundsen, Asgeir
  • Moaveni, Ash
  • Carr, Ashley
  • Sharma, Ateet
  • Hill, Austin D
  • Trommer, Axel
  • Rai, B Sachidananda
  • Hileman, Barbara
  • Schreurs, Bart
  • Verhoeven, Bart
  • Barden, Benjamin B
  • Flatøy, Bernhard
  • Cleffken, Berry I
  • Bøe, Berthe
  • Perey, Bertrand
  • Hanusch, Birgit C
  • Weening, Brad
  • Fioole, Bram
  • Rijbroek, Bram
  • Crist, Brett D
  • Halliday, Brett
  • Peterson, Brett
  • Mullis, Brian
  • Richardson, C Glen
  • Clark, Callum
  • Sagebien, Carlos A
  • van der Pol, Carmen C
  • Bowler, Carol
  • Humphrey, Catherine A
  • Coady, Catherine
  • Koppert, Cees L
  • Coles, Chad
  • Tannoury, Chadi
  • DePaolo, Charles J
  • Gayton, Chris
  • Herriott, Chris
  • Reeves, Christina
  • Tieszer, Christina
  • Dobb, Christine
  • Anderson, Christopher G
  • Sage, Claire
  • Cuento, Claudine
  • Jones, Clifford B
  • Bosman, Coks HR
  • Linehan, Colleen
  • van der Hart, Cor P
  • Henderson, Corey
  • Lewis, Courtland G
  • Davis, Craig A
  • Donohue, Craig
  • Mauffrey, Cyril
  • Sundaresh, DC
  • Farrell, Dana J
  • Whelan, Daniel B
  • Horwitz, Daniel
  • Stinner, Daniel
  • Viskontas, Darius
  • Roffey, Darren M
  • Alexander, David
  • Karges, David E
  • Hak, David
  • Johnston, David
  • Love, David
  • Wright, David M
  • Zamorano, David P
  • Goetz, David R
  • Sanders, David
  • Stephen, David
  • Yen, David
  • Bardana, Davide
  • Olakkengil, Davy J
  • Lawson, Deanna
  • Maddock, Deborah
  • Sietsema, Debra L
  • Pourmand, Deeba
  • Den Hartog, Dennis
  • Donegan, Derek
  • Heels-Ansdell, Diane
  • Nam, Diane
  • Inman, Dominic
  • Boyer, Dory
  • Li, Doug
  • Gibula, Douglas
  • Price, Dustin M
  • Watson, Dylan J
  • Hammerberg, E Mark
  • Tan, Edward TCH
  • de Graaf, Eelco JR
  • Vesterhus, Elise Berg
  • Roper, Elizabeth
  • Edwards, Elton
  • Schemitsch, Emil H
  • Hammacher, Eric R
  • Henderson, Eric R
  • Whatley, Erica
  • Torres, Erick T
  • Vermeulen, Erik GJ
  • Finn, Erin
  • Van Lieshout, Esther MM
  • Wai, Eugene K
  • Bannister, Evan R
  • Kile, Evelyn
  • Theunissen, Evert BM
  • Ritchie, Ewan D
  • Khan, Farah
  • Moola, Farhad
  • Howells, Fiona
  • de Nies, Frank
  • van der Heijden, Frank HWM
  • de Meulemeester, Frank RAJ
  • Frihagen, Frede
  • Nilsen, Fredrik
  • Schmidt, G Ben
  • Albers, GH Robert
  • Gudger, Garland K
  • Johnson, Garth
  • Gruen, Gary
  • Zohman, Gary
  • Sharma, Gaurav
  • Wood, Gavin
  • Tetteroo, Geert WM
  • Hjorthaug, Geir
  • Jomaas, Geir
  • Donald, Geoff
  • Rieser, Geoffrey Ryan
  • Reardon, Gerald
  • Slobogean, Gerard P
  • Roukema, Gert R
  • Visser, Gijs A
  • Moatshe, Gilbert
  • Horner, Gillian
  • Rose, Glynis
  • Guyatt, Gordon
  • Chuter, Graham
  • Etherington, Greg
  • Rocca, Gregory J Della
  • Ekås, Guri
  • Dobbin, Gwendolyn
  • Lemke, H Michael
  • Curry, Hamish
  • Boxma, Han
  • Gissel, Hannah
  • Kreder, Hans
  • Kuiken, Hans
  • Brom, Hans LF
  • Pape, Hans-Christoph
  • van der Vis, Harm M
  • Bedi, Harvinder
  • Vallier, Heather A
  • Brien, Heather
  • Silva, Heather
  • Newman, Heike
  • Viveiros, Helena
  • van der Hoeven, Henk
  • Ahn, Henry
  • Johal, Herman
  • Rijna, Herman
  • Stockmann, Heyn
  • Josaputra, Hong A
  • Carlisle, Hope
  • van der Brand, Igor
  • Dawson, Imro
  • Tarkin, Ivan
  • Wong, Ivan
  • Parr, J Andrew
  • Trenholm, J Andrew
  • Goslings, J Carel
  • Amirault, J David
  • Broderick, J Scott
  • Snellen, Jaap P
  • Zijl, Jacco AC
  • Ahn, Jaimo
  • Ficke, James
  • Irrgang, James
  • Powell, James
  • Ringler, James R
  • Shaer, James
  • Monica, James T
  • Biert, Jan
  • Bosma, Jan
  • Brattgjerd, Jan Egil
  • Frölke, Jan Paul M
  • Wille, Jan
  • Rajakumar, Janakiraman
  • Walker, Jane E
  • Baker, Janell K
  • Ertl, Janos P
  • de Vries, Jean Paul PM
  • Gardeniers, Jean WM
  • May, Jedediah
  • Yach, Jeff
  • Hidy, Jennifer T
  • Westberg, Jerald R
  • Hall, Jeremy A
  • van Mulken, Jeroen
  • McBeth, Jessica Cooper
  • Hoogendoorn, Jochem
  • Hoffman, Jodi M
  • Cherian, Joe Joseph
  • Tanksley, John A
  • Clarke-Jenssen, John
  • Adams, John D
  • Esterhai, John
  • Tilzey, John F
  • Murnaghan, John
  • Ketz, John P
  • Garfi, John S
  • Schwappach, John
  • Gorczyca, John T
  • Wyrick, John
  • Rydinge, Jonas
  • Foret, Jonathan L
  • Gross, Jonathan M
  • Keeve, Jonathan P
  • Meijer, Joost
  • Scheepers, Joris JG
  • Baele, Joseph
  • O'Neil, Joseph
  • Cass, Joseph R
  • Hsu, Joseph R
  • Dumais, Jules
  • Lee, Julia
  • Switzer, Julie A
  • Agel, Julie
  • Richards, Justin E
  • Langan, Justin W
  • Turckan, Kahn
  • Pecorella, Kaili
  • Rai, Kamal
  • Aurang, Kamran
  • Shively, Karl
  • van Wessem, Karlijn
  • Moon, Karyn
  • Eke, Kate
  • Erwin, Katie
  • Milner, Katrine
  • Ponsen, Kees Jan
  • Mills, Kelli
  • Apostle, Kelly
  • Johnston, Kelly
  • Trask, Kelly
  • Strohecker, Kent
  • Stringfellow, Kenya
  • Kruse, Kevin K
  • Tetsworth, Kevin
  • Mitchell, Khalis
  • Browner, Kieran
  • Hemlock, Kim
  • Carcary, Kimberly
  • Jørgen Haug, Knut
  • Noble, Krista
  • Robbins, Kristin
  • Payton, Krystal
  • Jeray, Kyle J
  • Rubino, L Joseph
  • Nastoff, Lauren A
  • Leffler, Lauren C
  • Stassen, Laurents PS
  • O'Malley, Lawrence K
  • Specht, Lawrence M
  • Thabane, Lehana
  • Geeraedts, Leo MG
  • Shell, Leslie E
  • Anderson, Linda K
  • Eickhoff, Linda S
  • Lyle, Lindsey
  • Pilling, Lindsey
  • Buckingham, Lisa
  • Cannada, Lisa K
  • Wild, Lisa M
  • Dulaney-Cripe, Liz
  • Poelhekke, Lodewijk MSJ
  • Govaert, Lonneke
  • Ton, Lu
  • Kottam, Lucksy
  • Leenen, Luke PH
  • Clipper, Lydia
  • Jackson, Lyle T
  • Hampton, Lynne
  • de Waal Malefijt, Maarten C
  • Simons, Maarten P
  • van der Elst, Maarten
  • Bronkhorst, Maarten WGA
  • Bhatia, Mahesh
  • Swiontkowski, Marc
  • Lobo, Margaret J
  • Swinton, Marilyn
  • Pirpiris, Marinis
  • Molund, Marius
  • Gichuru, Mark
  • Glazebrook, Mark
  • Harrison, Mark
  • Jenkins, Mark
  • MacLeod, Mark
  • de Vries, Mark R
  • Butler, Mark S
  • Nousiainen, Markku
  • van 't Riet, Martijne
  • Tynan, Martin C
  • Campo, Martin
  • Eversdijk, Martin G
  • Heetveld, Martin J
  • Richardson, Martin
  • Breslin, Mary
  • Fan, Mary
  • Edison, Matt
  • Napierala, Matthew
  • Knobe, Matthias
  • Russ, Matthias
  • Zomar, Mauri
  • de Brauw, Maurits
  • Esser, Max
  • Hurley, Meghan
  • Peters, Melissa E
  • Lorenzo, Melissa
  • Li, Mengnai
  • Archdeacon, Michael
  • Biddulph, Michael
  • Charlton, Michael
  • McDonald, Michael D
  • McKee, Michael D
  • Dunbar, Michael
  • Torchia, Michael E
  • Gross, Michael
  • Hewitt, Michael
  • Holt, Michael
  • Prayson, Michael J
  • Edwards, Michael JR
  • Beckish, Michael L
  • Brennan, Michael L
  • Dohm, Michael P
  • Kain, Michael SH
  • Vogt, Michelle
  • Yu, Michelle
  • Verhofstad, Michiel HJ
  • Segers, Michiel JM
  • Segers, Michiel JM
  • Siroen, Michiel PC
  • Reed, Mike
  • Vicente, Milena R
  • Bruijninckx, Milko MM
  • Trivedi, Mittal
  • Bhandari, Mohit
  • Moore, Molly M
  • Kunz, Monica
  • Smedsrud, Morten
  • Palla, Naveen
  • Jain, Neeraj
  • Out, Nico JM
  • Simunovic, Nicole
  • Simunovic, Nicole
  • Schep, Niels WL
  • Müller, Oliver
  • Guicherit, Onno R
  • Van Waes, Oscar JF
  • Wang, Otis
  • Doornebosch, Pascal G
  • Seuffert, Patricia
  • Hesketh, Patrick J
  • Weinrauch, Patrick
  • Duffy, Paul
  • Keller, Paul
  • Lafferty, Paul M
  • Pincus, Paul
  • Tornetta, Paul
  • Zalzal, Paul
  • McKay, Paula
  • Cole, Peter A
  • de Rooij, Peter D
  • Hull, Peter
  • Go, Peter MNYM
  • Patka, Peter
  • Siska, Peter
  • Weingarten, Peter
  • Kregor, Philip
  • Stahel, Philip
  • Stull, Philip
  • Wittich, Philippe
  • de Rijcke, Piet AR
  • Oprel, Pim
  • Devereaux, Philip
  • Zhou, Qi
  • Lee Murphy, R
  • Alosky, Rachel
  • Clarkson, Rachel
  • Moon, Raely
  • Logishetty, Rajanikanth
  • Nanda, Rajesh
  • Sullivan, Raymond J
  • Snider, Rebecca G
  • Buckley, Richard E
  • Iorio, Richard
  • Farrugia, Richard J
  • Jenkinson, Richard
  • Laughlin, Richard
  • Groenendijk, Richard PR
  • Gurich, Richard W
  • Worman, Ripley
  • Silvis, Rob
  • Haverlag, Robert
  • Teasdall, Robert J
  • Korley, Robert
  • McCormack, Robert
  • Probe, Robert
  • Cantu, Robert V
  • Huff, Roger B
  • Simmermacher, Rogier KJ
  • Peters, Rolf
  • Pfeifer, Roman
  • Liem, Ronald
  • Wessel, Ronald N
  • Verhagen, Ronald
  • Vuylsteke, Ronald
  • Leighton, Ross
  • McKercher, Ross
  • Poolman, Rudolf W
  • Miller, Russell
  • Bicknell, Ryan
  • Finnan, Ryan
  • Khan, Ryan M
  • Mehta, Samir
  • Vang, Sandy
  • Singh, Sanjay
  • Anand, Sanjeev
  • Anderson, Sarah A
  • Dawson, Sarah A
  • Marston, Scott B
  • Porter, Scott E
  • Watson, Scott T
  • Festen, Sebastiaan
  • Lieberman, Shane
  • Puloski, Shannon
  • Bielby, Shea A
  • Sprague, Sheila Ann
  • Hess, Shelley
  • MacDonald, Shelley
  • Evans, Simone
  • Bzovsky, Sofia
  • Hasselund, Sondre
  • Lewis, Sophie
  • Ugland, Stein
  • Caminiti, Stephanie
  • Tanner, Stephanie L
  • Zielinski, Stephanie M
  • Shepard, Stephanie
  • Sems, Stephen A
  • Walter, Stephen
  • Doig, Stephen
  • Finley, Stephen H
  • Kates, Stephen
  • Lindenbaum, Stephen
  • Kingwell, Stephen P
  • Csongvay, Steve
  • Papp, Steve
  • Buijk, Steven E
  • Rhemrev, Steven J
  • Hollenbeck, Steven M
  • van Gaalen, Steven M
  • Yang, Steven
  • Weinerman, Stuart
  • Subash
  • Lambert, Sue
  • Liew, Susan
  • Meylaerts, Sven AG
  • Blokhuis, Taco J
  • de Vries Reilingh, Tammo S
  • Lona, Tarjei
  • Scott, Taryn
  • Swenson, Teresa K
  • Endres, Terrence J
  • Axelrod, Terry
  • van Egmond, Teun
  • Pace, Thomas B
  • Kibsgård, Thomas
  • Schaller, Thomas M
  • Ly, Thuan V
  • Miller, Timothy J
  • Weber, Timothy
  • Le, Toan
  • Oliver, Todd M
  • Karsten, Tom M
  • Borch, Tor
  • Hoseth, Tor Magne
  • Nicolaisen, Tor
  • Ianssen, Torben
  • Rutherford, Tori
  • Nanney, Tracy
  • Gervais, Trevor
  • Stone, Trevor
  • Schrickel, Tyson
  • Scrabeck, Tyson
  • Ganguly, Utsav
  • Naumetz, V
  • Frizzell, Valda
  • Wadey, Veronica
  • Jones, Vicki
  • Avram, Victoria
  • Mishra, Vimlesh
  • Yadav, Vineet
  • Arora, Vinod
  • Tyagi, Vivek
  • Borsella, Vivian
  • Willems, W Jaap
  • Hoffman, WH
  • Gofton, Wade T
  • Lackey, Wesley G
  • Ghent, Wesley
  • Obremskey, William
  • Oxner, William
  • Cross, William W
  • Murtha, Yvonne M
  • Murdoch, Zoe

publication date

  • April 2017