OTA 2016: Result of the Multinational FAITH Hip Fracture Trial

Study Type: Randomized Trial
OE Level of Evidence: 1
Journal Level of Evidence: N/A
OE EXCLUSIVE
Dr. Marc Swiontkowski discusses the results of the FAITH trial.
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Synopsis
1108 patients with low-energy femoral neck fractures were randomized to internal fixation with a sliding hip screw or cancellous screws. The objective of this study was to compare the rates of re-operation, complications (avascular necrosis, nonunion, implant failure, and infection), and health-related quality of life between the two methods of internal fixation over a 24-month follow-up period. The results of Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Non-Industry funded
Sponsor: National Institutes of Health, Canadian Institutes of Health Research, Stichting NutsOhra, Netherlands Organisation for Health Research and Development, and Physicians' Services Incorporated.
Conflicts: Other
Why was this study needed now?
The surgical management of hip fractures remains a contentious issue among orthopaedic surgeons. The high proportion of patients requiring reoperations following the fixation of femoral neck fractures has highlighted the need to identify an optimal approach for the surgical management of these fractures to reduce morbidity, mortality, and costs. A number of small randomized trials have been conducted on the topic; however, the sample sizes of these trials limit the applicability of their findings to clinical practice, indicating the need for a large well designed randomized trial.
What was the principal research question?
In the surgical management of low-energy femoral neck fractures, were there significant differences in the re-operation rate between sliding hip screw and cancellous screws when evaluated over a 24-month follow-up?
Population: 1108 patients, 50 years or older, with low-energy femoral neck fracture requiring operative management.
Intervention: Sliding Hip Screw: Patients received a single (8.0mm diameter) partially threaded screw attached to the proximal femur with a side plate. (n=557; Mean age: 72.2+/-12.0)
Comparison: Cancellous Screws: Patients received multiple threaded screws, with a minimum of two screws (6.5 mm diameter). (n=551; Mean age: 72.0+/-12.3)
Outcomes: The primary outcome of this study was re-operation, including to promote fracture healing, relieve pain, treat infection, or improve function. Secondary outcomes included mortality, fracture healing, complications (avascular necrosis, nonunion, implant failure, and infection), and measures of health-related quality of life (Short Form 12-Item General Health Survey [SF-12], EuroQol-5 Dimensions [EQ-5D], and the Western Ontario and McMaster Universities Arthritis Index [WOMAC]).
Methods: RCT; international multi-center (81 sites)
Time: Follow-ups were conducted at 1-week, 10 weeks, 6, 9, 12, 18, and 24 months.
What were the important findings?
CONTENT IS LOCKED
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.