Grant: Operating Grant

Hip fractures occur in 280,000 Americans (over 5000 per week) and 36,000 Canadians annually. The number of hip fractures is likely to exceed 500,000 annually in the United States and 88,000 in Canada as the population ages. Hip fractures can be fixed with multiple cancellous screws or a single large screw with a plate (sliding hip screw). Experimental data suggest that multiple cancellous screws offer greater preservation of blood and supply while sliding hip screws provide greater biomechanical stability to bending stresses. Although clinical studies suggest that a sliding screw may reduce re-operation rates, the evidence remains far from definitive. We, therefore, propose multi-centre, concealed randomized study. Surgeons will use one of two surgical strategies in 1,500 patients who have sustained a femoral neck fracture. The first strategy involves fixation of the fracture with multiple small diameter cancellous screws (cancellous screw group). The second treatment strategy involves fixation of the fracture with a single larger diameter screw with a side plate (sliding hip screw group). Study personnel will monitor critical aspects of peri-operative care and rehabilitation. Our primary outcome is the need for revision surgery and our secondary outcomes include patient function and quality of life. We will independently adjudicate revision surgeries that occur within 2 years of the initial fixation.