***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 
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    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 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 Summary : Achieving bony union and early weight bearing in peritrochanteric femur fractures poses a continuous challenge for the orthopedic surgeon . Current st and ards of surgical fixation for the myriad possible fracture patterns include the compression hip screw ( CHS ) , the 90 ° /95 ° blade plate , and locked intramedullary nails . The gamma nail ( GN ) was design ed as a “ hybrid ” of these devices , combining theoretical biomechanical advantages that should allow earlier postoperative weight bearing with surgical technique advantages that should decrease operative morbidity . Because these theoretical advantages were unproven in a clinical setting , we prospect ively r and omized 75 consecutive patients with peritrochanteric femur fractures into two groups to examine the fixation of these fractures with the GN as compared to the CHS . We found no significant differences in preoperative or intraoperative parameters . Postoperatively , the subtrochanteric fracture group treated with the GN  achieved earlier weightbearing status , although this was not statistically significant . 72 patients were available for follow-up at a minimum of 6 months .  All fractures had clinical ly and radiographically healed , and 94 % of the patients continued to be ambulatory . Major complications included missed distal locking screws ( one patient ) , cutting out of the lag screw superiorly in the femoral head ( two patients ) , and a femur fracture at the distal end of the GN ( one patient ) . In our series , the GN produced clinical results commensurate with current st and ards of fixation for peritrochanteric femur fractures . Although the GN allowed earlier independent weightbearing status in patients with subtrochanteric fractures , the procedure was technically more dem and ing and had a significant learning curve OBJECTIVES To present several alternative approaches to describing the range and functional outcomes of patients with hip fracture . DESIGN Prospect i ve study with concurrent medical records data collection and patient and proxy interviews at the time of hospitalization and 6 months later . SETTING Four hospitals in the New York metropolitan area . PARTICIPANTS Five hundred seventy-one hospitalized adults aged 50 and older with hip fracture between July 1997 and August 1998 . MEASUREMENTS Rates of return to function in four physical domains , mortality , and nursing home residence at 6 months . Cluster analysis was used to describe the heterogeneity among the sample and identify variations in 6-month mortality , nursing home residence , and level of functioning and to develop a patient classification tree with associated patient outcomes at 6 months postfracture . RESULTS In locomotion , transfers , and self-care , 33 % to 37 % of patients returned to their prior level of function by 6 months , including those needing assistance , but only 24 % were independent in locomotion at 6 months . Cluster analysis identified eight patient subgroups that had distinct baseline features and variable outcomes at 6 months . The patient classification tree used four variables : atypical functional status ( independent in locomotion but dependent in other domains ) ; nursing home residence ; independence/dependence in self-care ; and age younger than 85 or 85 and older that identified five subgroups with variable 6-month outcomes that clinicians may use to predict likely outcomes for their patients . CONCLUSION Patients with hip fracture are heterogeneous with respect to baseline and outcome characteristics . Clinicians may be better able to give patients and caregivers information on expected outcomes based on presenting characteristics used in the classification tree This prospect i ve r and omized study compared the outcome of elderly patients with an unstable pertrochanteric fracture , treated with a proximal femoral nail antirotation device ( PFNA ; n = 51 ) or a dynamic hip screw ( DHS ; n = 55 ) . All patients in the DHS group and nine in the PFNA group had open reductions . Incisions were significantly shorter for the PFNA than the DHS group . Blood loss and the number of patients requiring postoperative blood transfusions were significantly greater , but operation and fluoroscopy times were significantly shorter , for the DHS versus the PFNA group . Time to mobilization with a frame was significantly shorter in the PFNA group , and post-operative complications were more common in the DHS group . Poor fracture reduction led to three revisions . All fractures in both groups united during follow-up . The PFNA allowed earlier mobilization and faster recovery than the DHS . The PFNA is a highly acceptable , minimally invasive implant for unstable fractures Objectives : To compare the results between a new intramedullary Gamma nail and a compression hip screw in the treatment of trochanteric fractures . Design : Prospect i ve r and omized . Setting : Level 1 trauma center . Patients : Two hundred ten consecutive patients older than 65 years with trochanteric femoral fractures . Interventions : Treatment with a compression hip screw or a new design of the Trochanteric Gamma nail ( 180 mm in length with a mediolateral angle of 4 ° and available only with a proximal diameter of 17 mm and distal diameter of 11 mm ) . Main Outcome Measurements : Operative and fluoroscopy times , blood loss , functional outcome , complication rate , and failure of fixation . Results : The Trochanteric Gamma nail  was used in 104 patients and the compression hip screw in 106 . The 2 groups were similar in terms of their preoperative data , with a median follow-up of 13.6 months ( range 12 - 30 ) . The results show no difference in operating time ( P = 0.21 ) , but the Trochanteric Gamma nail group had a significantly shorter fluoroscopy time ( P = 0.006 ) , and the number of patients transfused and the mean of units of blood transfused were significantly less in the Trochanteric Gamma nail group ( P = 0.013 , 0.046 , respectively ) . Mortality within 12 months was similar in both groups ( P = 0.83 ) . All fractures were radiographically healed at the last visit . There was no difference in intraoperative and postoperative complications or rate of fixation failure between the 2 groups , and no case of secondary shaft fracture of the femur was encountered in this study . In the entire series , there was no difference in the functional outcome ( P = 0.74 ) , but the postoperative walking ability was better in those patients with unstable fractures who were treated with the Trochanteric Gamma nail ( P = 0.017 ) . Conclusions : The new Trochanteric Gamma nail is an effective method for the treatment of trochanteric femoral fractures in elderly patients . The indication for either Trochanteric Gamma nail or compression hip screw is similar in stable fractures , but we recommend the use of the Trochanteric Gamma nail for unstable trochanteric fractures A prospect i ve , r and omised , controlled trial was performed to compare the outcome of treatment of unstable trochanteric fractures with either a short proximal femoral nail antirotation ( PFNA ) or dynamic hip screw ( DHS ) .  Eighty one patients with unstable fracture of the proximal part of the femur were r and omised , at the time of admission , for fixation with either a short PFNA ( n=42 ) or DHS ( n= 39 ) . The primary outcome measure was reoperation within the first postoperative year and mortality at the end of one year . Operative time , fluoroscopy time , blood loss , and any intra-operative complication were recorded for each patient . Clinical and radiological follow-up was undertaken for a minimum of 36 months . Any changes in the position of the implant or fixation failure were recorded . Hip range of motion , pain in the hip or thigh and return to work were used to compare the outcomes . There was no significant difference between 1 year mortality rates for the two groups . The mean operative time was significantly less in PFNA group ( 25 min ) than in the DHS group ( 38 min ) . Patients treated with a PFNA experienced a shorter fluoroscopy time and less blood loss . Six patients in DHS group had implant failure while none experienced this in PFNA group . The PFNA group had a better functional outcome than the DHS group We report a prospect i ve , r and omized , controlled trial , comparing the results of treatment with a dynamic hip screw ( DHS ) and a gamma nail in 95 consecutive patients with peri-trochanteric fractures of the femur . The  DHS was used in 48 patients , the gamma nail in 47 .  Clinical and radiological outcomes were similar , but the gamma nail was associated with a higher incidence of complications , in particular fracture of the femur below the implant in eight cases . This is consistent with previous reports , and we do not recommend the gamma nail for the treatment of peri-trochanteric femoral fractures A prospect i ve , r and omized study comparing the compression hip screw with the Gamma nail in the treatment of 426 intertrochanteric fractures is reported . The median patient age was 80 years , and 71 % were women The compression hip screw operation took less time except in Evans Type 5 fractures .  Blood loss generally was less in the compression hip screw group except in patients with Type 5 fractures . The most frequent surgical problem for patients in the Gamma group was problems with distal locking . Cephalic position of the femoral head screw and cut-out were seen more often in the Gamma nail group . The Gamma nail more frequently preserved the fracture position obtained perioperatively . Whether there was distal locking of the Gamma nail in unstable fractures did not seem to affect the healing rate . Additional fissures or fractures in the proximal femur occurred during five Gamma nail operations and two compression hip screw operations . Postoperative walking ability did not differ between the groups . At 6 months 88 % of the fractures were healed . In less comminuted fractures , the compression hip screw method is the preferred method of treatment whereas the Gamma nail is an alternative treatment for more comminuted Evans Type 5 fractures This prospect i ve , r and omized study compared the functional outcome and complications associated with a proximal femoral nail antirotation ( PFNA ) device with those of a traditional extramedullary device , the dynamic hip screw ( DHS ) , in patients with trochanteric fracture . A total of 121 patients were r and omized to the PFNA group ( n = 5 
    Output:
    
Across all population s , greater reductions in blood loss and operation time were observed for PFNA than for other treatments .
Conclusions The findings provide supporting evidence demonstrating the superiority of PFNA over other treatments for intertrochanteric femoral fracture .
PFNA treatment results in the lowest amount of blood loss and the shortest operation time .
These findings add to the existing knowledge of intertrochanteric femoral fracture treatment options