FAITH

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

Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) Investigators. Lancet (London, England) 2017 · PMID 28262269 · doi:10.1016/s0140-6736(17)30066-1

Question

For femoral neck fractures treated with internal fixation, does a sliding hip screw reduce reoperation compared with multiple cancellous screws?

Design

International multicentre RCT with concealed allocation; surgeons and patients unblinded, analyst blinded.

Patients

Adults aged 50 or over with a low-energy femoral neck fracture requiring internal fixation.

Intervention

Sliding hip screw

Comparison

Multiple cancellous screws

Primary outcome

Hip-related reoperation within 24 months

Key result

Reoperation at 24 months did not differ significantly between implants, but avascular necrosis was significantly more common with the sliding hip screw. Exploratory subgroups suggested possible benefit from the sliding hip screw in smokers and in displaced or basicervical fractures.

Limitations

Subgroup findings are hypothesis-generating only, and the overall reoperation rate was high, reflecting the limitations of fixation itself in this age group.

Impact on practice

Supports surgeon choice between cancellous screws and a sliding hip screw for undisplaced intracapsular fractures, with some favouring the sliding hip screw for basicervical patterns and in smokers.