***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Purpose The purpose of this prospect i ve r and omised trial was to assess whether an intramedullary nail is superior to a sliding hip screw in the treatment of multifragmentary intertrochanteric fractures Methods Eighty patients with a 31-A2.2 or A2.3 Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association ( AO/OTA ) intertrochanteric fracture were r and omly allocated to fixation with either the Gamma nail or the AMBI sliding hip screw device . Results All patients were followed up at one , three , six and 12 months postoperatively , except for nine who died . There was no statistical difference in Parker mobility score between groups . The Gamma nail group had significantly higher Barthel Index and EuroQol-5D ( EQ-5D ) scores than the AMBI group at 12 months . At the same time , the EQ-5D score had returned to its pre-operative values in the Gamma nail group but not in the AMBI group . There were no differences in mortality , radiation time and hospital stay . Duration of the operation , incision length and hip pain occurrence were significantly less in the Gamma nail group . Conclusions Few failures occur when unstable 31-A2.2 and A2.3 AO/OTA fractures are fixed with a sliding hip screw . Nevertheless , an intramedullary nail seems superior in reconstituting patients to their pre-operative state Objective To determine the mortality risk following hip fracture and identify factors predictive of increased mortality . Design Retrospective review of prospect ively collected data . Setting Tertiary care orthopaedic hospital . Background Approximately 250,000 hip fractures occur annually in the United States . The greatest mortality risk following hip fracture has been demonstrated to be within the first 6 months of fracture , and some studies report that the risk approaches expected mortality after 6 months . However , more recent studies have demonstrated that an increased risk of mortality may persist for several years postfracture . The purpose of this study was to assess the excess mortality associated with hip fracture at up to 2 years postinjury . Methods All patients with a hip fracture who were admitted to our institution over a 10-year period were evaluated . Criteria for inclusion included : Caucasian , age 65 or older , previously ambulatory , and home dwelling . Patients were followed prospect ively to determine the mortality risk associated with hip fracture over a 2-year follow-up period . Mortality was compared to a st and ardized population and st and ardized mortality ratios were calculated . Results Eight hundred thirty-six patients met the inclusion criteria and were included .  The mortality risk was highest within the first 3 months following fracture , with st and ardized mortality ratios approaching that of the control population by two years . Patients age 65–84 had higher mortality risk when compared with patients age ≥85 . American Society of Anesthesiologists classification was predictive of increased mortality risk in younger patients , with these patients having triple the mortality risk when compared to the reference population at 2-year follow-up . More elderly patients had minimal excess mortality associated with hip fracture at 1- and 2-year follow-up , regardless of ASA classification . Conclusion The data demonstrate that hip fracture is not associated with significant excess mortality amongst patients older than age 85 . Amongst younger patients , however , those with ASA classifications of 3 or 4 have significant excess mortality following hip fracture that persists up to 2 years after injury Background The treatment and management of hip fracture poses a great challenge for clinicians in osteology and surgery . The aim of this study is to compare the clinical effectiveness of the percutaneous compression plate ( PCCP ) versus proximal femoral nail anti-rotation ( PFNA ) in the treatment of intertrochanteric fractures in elderly patients . Methods A prospect i ve r and omized study was carried out from January 2008 to October 2011 involving 90 elderly patients with intertrochanteric fractures ( 90 hips ) who underwent minimally invasive surgery using the PCCP or PFNA .  Evaluation variables , including operation time , intra- and perioperative blood loss , duration of hospital stay , incidence of postoperative complications , and final clinical outcomes by the end of follow-up , were used to compare the benefits of these two implants . Results Among 90 subjects , 45 received PCCPs and 45 received PFNAs . The baseline characteristics of the two groups were comparable . The median follow-up time was 16.9 months ( 12–24 months ) . In the PCCP group , the mean operative time was 53 min ( 40–75 min ) , and the mean intra- and perioperative blood losses were 100.7 ml ( 60–150 ml ) and 916 ml ( 433–1339 ml ) , respectively , which were significantly lower than those in the PFNA group . Nevertheless , there was no statistical difference in the incidence of postoperative complications and final clinical outcomes including pain complaints , range of motion of the hip , postoperative hip function at 12 months , and the recovery of walking ability to pre-injury status between these two implants . Conclusions Overall , the PCCP and PFNA appear to have similar clinical effects in treating elderly patients with intertrochanteric fractures , although the PCCP provided shorter operation times and less blood loss than PFNA . Both implants discussed were demonstrated to be ideal for the treatment of femoral intertrochanteric fractures in elderly patients OBJECTIVE To examine the responsiveness of the 36-Item Short Form Health Survey ( SF-36 ) to clinical changes in three surgical groups and to study how health-related quality of life ( HRQL ) changes with time among patients who undergo total hip arthroplasty , thoracic surgery for treatment of non-small-cell lung cancer , or abdominal aortic aneurysm ( AAA ) repair . DESIGN Prospect i ve cohort study with serial evaluations of HRQL preoperatively and at 1 , 6 , and 12 months after surgery . SETTING University tertiary care hospital . PATIENTS Of 528 patients , more than 50 years of age , who were admitted for these elective procedures , 454 ( 86 % ) provided preoperative health status data and are members of the study cohort . At 12 months after surgery , 439 ( 93 % ) of the cohort was successfully contacted and 390 ( 90 % ) provided follow-up interviews . MEASUREMENTS AND MAIN RESULTS The Medical Outcomes Study SF-36 , the Specific Activity Scale , five vali date d health transition questions , and a 0 to 100 scale measure of global health were used to assess changes in health status at 1 , 6 , and 12 months after surgery . Change in health status as measured by the SF-36 demonstrated that physical function and role limitations due to physical health problems were worse 1 month after these three surgeries . However , by 6 months after surgery , most patients experienced significant gains in the majority of the dimensions of health , and these gains were sustained at 12 months after surgery . Longitudinal changes in the SF-36 were positively associated with responses to the five health transition questions , to changes on the Specific Activity Scale and global health rating question , and to clinical parameters for persons who had AAA repair . These findings indicate that the SF-36 has evidence of validity and is responsive to expected changes in HRQL after elective surgery for these procedures . CONCLUSIONS For the total hip arthroplasty patients , responsiveness was greatest for the SF-36 scales that measure physical constructs . However , for the two other procedures and at various points of recovery , significant changes were observed for all eight subscales , suggesting that responsiveness was dependent on the type of surgery and the timing of follow-up , and that multidimensional measures are needed to fully capture changes in HRQL after surgery One hundred thirty-one patients ( 135 fractures ) who sustained an intertrochanteric fracture were assigned r and omly to treatment with either a sliding hip screw or an intramedullary hip screw and followed up prospect ively . In patients with unstable intertrochanteric fractures , the intramedullary device was associated with 23 % less surgical time and 44 % less blood loss ; however , use of the intramedullary hip screw in patients who had a stable fracture pattern required 70 % greater fluoroscopic time . Intraoperative complications occurred exclusively in patients in the intramedullary hip screw group . There were no differences in the rates of functional recovery between the two fixation groups OBJECTIVE To compare the efficacy of the gamma nail ( GN ) to the dynamic hip screw ( DHS ) in the management of intertrochanteric hip fractures . DESIGN R and omized , prospect i ve clinical trial with a mean follow-up of 52 weeks ( range from 11 to 82 weeks ) . SETTING A university teaching hospital . PATIENTS One hundred and one patients with 102 fractures : 49 fractures were treated with the DHS and 53 fractures were treated with the GN .  INTERVENTIONS Fracture fixation with the DHS or the GN . MAIN OUTCOME MEASURES Comparison of duration of operation , blood loss , early and late complications , functional outcome and duration of hospital stay . RESULTS There was no significant difference between the two groups with respect to intraoperative blood loss , days in hospital , time to union and eventual functional outcome . The length of the procedure and fluoroscopy time were longer for the GN group . CONCLUSIONS Both the GN and the DHS can be used effectively for the treatment of intertrochanteric fractures . In this study the DHS was associated with a lower risk of local complications and should still be considered to be the implant of choice for patients with intertrochanteric fractures The Gamma nail was introduced for the treatment of peritrochanteric fractures with the theoretical advantage of a load-sharing femoral component which could be implanted by a closed procedure . We report a r and omised prospect i ve study of 186 fractures treated by either the Gamma nail or a dynamic hip screw . Gamma nails were implanted with significantly shorter screening times , smaller incisions , and less intraoperative bleeding . The  Gamma nail  group had a shorter convalescence and earlier full weight-bearing , but there was no significant difference in mortality within six months , postoperative mobility , or hip function at review . More intra-operative complications were recorded in the  Gamma nail group , mainly due to the mismatching of the femoral component of the nail to the small femurs of Chinese people . Use of a smaller modified nail reduced these complications . We conclude that with careful surgical technique and the modified femoral component , the Gamma nail is an advance in the treatment of peritrochanteric fractures Introduction : In this study , we initiated a prospect i ve , r and omised , clinical trial comparing the AMBI , TGN and PFN operations used for treatment of unstable fractures , for differences in intra-operative use , consolidation , complications and functional outcome . Material s and methods : We have compared the pre- , intra- and post-operating variables of AMBI , TGN and PFN operations that were used for treatment of unstable trochanteric fractures , of 120 patients all above 60 years old diagnosed with extracapsular hip fractures classified as AO Type 31-A2 or Type 31-A3 . Results : According to our results the three methods are comparable in the treatment of unstable trochanteric fractures  of patients above 60 years old . Conclusion : The AMBI remains the gold st and ard for the fractures of trochanteric region . TGN has an easier and faster procedure , facilitates early weight bearing and had minor late complications . An improper use of the PFN system was the reason for the most complications and the longer operation time of the device . PFN is also an accepted minimally invasive implant for unstable proximal femoral fractures but future modification of the implant to avoid Z-effect phenomenon , careful surgical technique and selection of the patients should reduce its high complication rate Objective . To compare two internal fixation devices clinical ly in stabilisation of intertrochanteric femur fractures . Methods . Eighty-seven patients were r and omised upon their admission to the hospital using a sealed envelope method . Forty-five were treated with proximal femur nail antirotation ( PFNA ) and 42 with reverse less invasive stabilisation system ( LISS ) . The perioperative data were recorded and compared in relation to fracture type . Results . In each type of fractures , no significant differences were found with respect to the blood loss , the quality of reduction , the time to bony healing , and the Harris hip score between the 2 groups . The mean duration of surgery was significantly longer in reverse LISS group than in PFNA group . Conclusion . Both the PFNA and the reversed LISS are effective in the treatment of different types of intertrochanteric femur fractures . PFNA is superior to reverse LISS in terms of surgical time , weight-bearing , and perhaps fluoroscopy time Clinicians are presented with problems that require evidence . R and omized controlled trials ( RCTs ) are considered the optimal study design for evaluating the effect of a new medical or surgical intervention . Surgical RCTs are carried out less often than RCTs of medical interventions , partly because using RCTs to evaluate surgical or interventional procedures is difficult and dem and s special consideration of issues such as blinding and the effects of surgeon factor , learning curve and differences in preor postprocedural care . Despite these obstacles , RCTs are becoming more common as surgeons in many specialties become acquainted with the proper methodology for health research . The mere description of a study as “ r and omized ” does not allow clinicians to infer validity — to base inferences on the accuracy of the results drawn from the sample of patients studied ( internal validity ) or the generalizability of these results to other setting s ( external validity ) . The purpose of this article is to review , within a framework of a critical appraisal of surgical RCTs , strateg 
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Because of these , no statistically significant differences were present from most of the comparisons across all the outcomes , and no definitive conclusions can be made .