INSITE - Trochanteric Hip Fracture Management Trial.

Emil Schemitsch

FRCSC

Professor, University of western Ontario

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Mohit Bhandari

FRCSC, PhD

Distinguished University Professor, Chair of Surgery, McMaster University

This interview outlines the INSITE trial, a large multinational RCT comparing intramedullary nails with sliding hip screws for trochanteric hip fractures in previously ambulatory adults. Despite longstanding assumptions that nails might offer superior early function, especially in unstable patterns, the trial found no meaningful differences in function, reoperation, or major complications at one year across 850 participants. Results reinforce over a decade of evidence—now exceeding 7,000 pooled patients—showing clinical equivalence for most A1–A2 fractures, with only rare patterns (e.g., reverse obliquity) remaining exceptions. Discussion highlights the need for continued trials to shift entrenched surgical practice and underscores robust safeguards around industry funding, emphasizing the independence of the writing committee and publication decisions.