Summary 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.

Rotator cuff lesion is a common shoulder disorder, with a prevalence ranging from 13% in people over 50 years of age to more than 50% in people over 80 years of age. 24 Two thirds of these lesions are asymptomatic, usually due to their small size. 30 One third are accompanied by symptoms such as pain, muscle weakness, and loss of shoulder range of motion (ROM). 3,17,26 For these people, a rotator cuff lesion may lead to restrictions in their daily functioning, and surgical repair of the rotator cuff using an arthroscopic procedure can be a potential solution. 12,27,29 Although an arthroscopic rotator cuff repair appears to be a relatively minor procedure, postsurgical rehabilitation is long and intensive. Generally, the first weeks after surgery are often painful, and the patient should anticipate several months of physiotherapy. 11,22 However, the extent and duration of the recovery period may vary widely among patients. 18 Recovery can be defined and measured in several ways: impairments (ROM, strength), function (self-report questionnaires), quality-of-life (QoL questionnaires), pain, satisfaction, and tendon healing (ultrasound or magnetic resonance imaging [MRI]).Several factors can affect the extent to which a person will recover after rotator cuff repair. In the literature, factors such as demographics, clinical variables, cuff integrity, and surgical procedure are mentioned as being prognostic of recovery. 8,14,25,26 Better knowledge of these prognostic factors may lead to improved insight for physiotherapists and orthopaedic surgeons to predict the extent of the recovery and adjust rehabilitation and patient expectations accordingly. 9Multiple prospective and retrospective studies have been published that describe prognostic factors after rotator cuff repair; however, to our knowledge, no systematic review of that informa-T T STUDY DESIGN: Systematic literature review. T T OBJECTIVES:To perform a systematic review of the literature on prognostic factors for successful recovery after arthroscopic rotator cuff repair. T T BACKGROUND:Rotator cuff lesion is a common shoulder disorder, with a prevalence ranging from 13% in people over 50 years of age to more than 50% in people over 80 years of age. Several factors can affect the extent to which a person will recover after the surgical repair of a rotator cuff tear. More knowledge about these prognostic factors may lead to a better understanding of why the recovery process is successful in some patients but not in others. T T METHODS:A systematic literature search from 1995 to November 2013 was performed to identify studies reporting prognostic factors for successful recovery after arthroscopic rotator cuff repair. T T RESULTS:A total of 455 studies were initially identified, 10 of which were included in the review. For all included studies, the percentage of patients with complete tendon healing at final assessment ranged from 60% to 88%. Twelve prognostic factors, which could be divided into 4 categories, were identified as being associated with better reco...

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A combination of lateral and oblique radiographs can be used to differentiate between anteromedial and anterolateral bony ankle impingement.