***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: OBJECTIVE To show that patients with intertrochanteric fractures treated with a proximal femoral nail  have a better postoperative course than those treated with a DHS plate ( dynamic hip screw ) . METHODS Patients with a Boyd & Griffin type II intertrochanteric fracture were r and omly divided into two groups : a group of patients treated with a PFN and another one treated with a DHS plate . All patients were assessed at 2 , 4 , 8 and 16 weeks using the Harris scale and the visual analog scale pre- and postoperatively , as well as the operative time , incision size , intraoperative bleeding , onset of partial and /or total weight bearing , healing time , time to attain prior physical activity level , and radiographic result . RESULTS 32 patients met our criteria . The variables that had a significant reduction were : incision , operative time , postoperative pain according to the visual analog scale , onset of mobility , partial weight bearing and pain at 2 weeks . CONCLUSIONS The proximal femoral nail has better short-term outcomes than the DHS plate ; however , in the medium term both implants have the same outcomes Proximal femur fractures ( PFF ) , place a heavy dem and on orthopaedic departments worldwide . In Engl and it is estimated that by year 2020 , 100,000 patients annually with PFF will require surgical fixation . There are unique challenges as those with PFF are older , by definition have increased co-morbidities and predisposition factors and conditions such as osteoporosis . It is of note that globally around 13 % of the population are over 65 years of age and not surprisingly 1.6 million hip fractures are secondary to osteoporosis . Interestingly , besides osteoporosis , while many other factors have been suggested to increase the risk of PFF , in Europe a high BMI decreases the incidence of hip fractures . Despite a number of initiatives , advances and guidelines that have been implemented disappointingly mortality for PFF has not changed significantly in 40 years . For this reason , PFF remain a focused topic for both commissioners and providers of health care and for the clinicians a subject of ongoing research activity . Optimising patient ’s pre and post-surgery , has been reinforced by NICE guidelines and target driven hospital remuneration in an attempt to reduce mortality , which is estimated to be 10 % at 30 days and 31 % at 3 months . Thus , early identification and the ability to predict those patients who are likely to have adverse postoperative outcomes is critical . It enables a focus of re sources and the use of adjunctive therapies . Hu et al ’s meta- analysis showed that such factors have been identified as predictive of high mortality as advanced age , male gender , nursing home or facility residence , poor preoperative walking capacity , poor activities of daily living , higher ASA grading , poor mental state , multiple co morbidities , dementia or cognitive impairment , diabetes , cancer and cardiac disease . At five years post-surgical fixation , Abbreviated Mental Test Score , mobility and living circumstances have a predicted value in mortality . Some of these factors can be identified from simply good admission clerking . Not surprisingly therefore , st and ard proforma ’s have been introduced in a number of countries to facilitate good clerking and co-ordination of a multidisciplinary approach . Nonetheless , there is lack of a large prospect i ve study establishing whether this translates into improved patient outcomes . With pressure on re sources , two hospitals in Engl and have adopted efficiency ideology from the car manufacturer Toyota , known as the ‘ ‘ Lean ’ ’ principle . It aims to improve outcomes of care at key stages of hip fracture management . Essentially the patients are aggressively moved through the patient journey from presentation to discharge , through a multidisciplinary approach aim ed at optimisation physiologically and socially to return We compared the outcome of patients treated for an intertrochanteric fracture of the femoral neck with a locked  , long intramedullary nail with those treated with a dynamic hip screw ( DHS )  in a prospect i ve r and omised study . Each patient who presented with an extra-capsular hip fracture was r and omised to operative stabilisation with either a long intramedullary Holl and nail or a DHS . We treated 92 patients with a Holl and nail and 98 with a DHS .  Pre-operative variables included the Mini Mental test score , patient mobility , fracture pattern and American Society of Anesthesiologists grading . Peri-operative variables were anaesthetic time , operating time , radiation time and blood loss . Post-operative variables were time to mobilising with a frame , wound infection , time to discharge , time to fracture union , and mortality . We found no significant difference in the pre-operative variables . The mean anaesthetic and operation times were shorter in the DHS group than in the Holl and nail group ( 29.7 vs 40.4 minutes , p < 0.001 ; and 40.3 vs 54 minutes , p < 0.001 , respectively ) . There was an increased mean blood loss within the DHS group versus the Holl and nail group ( 160 ml vs 78 ml , respectively , p < 0.001 ) . The mean time to mobilisation with a frame was shorter in the Holl and nail group ( DHS 4.3 days , Holl and nail 3.6 days , p = 0.012 ) . More patients needed a post-operative blood transfusion in the DHS group ( 23 vs seven , p = 0.003 ) and the mean radiation time was shorter in this group ( DHS 0.9 minutes vs Holl and nail 1.56 minutes , p < 0.001 ) . The screw of the DHS cut out in two patients , one of whom underwent revision to a Holl and nail . There were no revisions in the Holl and nail group . All fractures in both groups were united when followed up after one year . We conclude that the DHS can be implanted more quickly and with less exposure to radiation than the Holl and nail . However , the result ant blood loss and need for transfusion is greater . The Holl and nail allows patients to mobilise faster and to a greater extent . We have therefore adopted the Holl and nail as our preferred method of treating intertrochanteric fractures of the hip Methods Among 985 Olmsted County , Minnesota , residents who experienced an osteoporotic fracture ( distal forearm , humerus , clavicle/scapula/sternum , ribs , vertebrae , pelvis , hip , other femur or tibia/fibula [ the latter in women only ] ) , we estimated the incremental cost of direct medical care in the following year compared with age- and sex-matched controls without a fracture r and omly sample d from the same community . Results The overall median incremental ( case minus control ) cost in the succeeding year was $ 2390 , with a particularly high incremental cost for hip fractures ( $ 11,241 ) . There was fair concordance between the incremental cost of the different fractures , relative to hip fracture alone , and the previously published disutility associated with each fracture type relative to hip fracture . Overall , the incremental cost for all osteoporotic fractures combined was 46 % greater than that for hip fractures alone in women and 47 % greater in men . This is consistent with the earlier report that overall morbidity from all osteoporotic fractures combined is 47 % and 39 % greater in women and men , respectively , than the morbidity attributable solely to hip fractures . Conclusion These data lend support to the notion that other osteoporotic fractures can be quantified relative to hip fracture on the basis of their cost , as well as their morbidity and mortality . This may simplify health economic analyses by allowing all fracture outcomes to be modeled relative to hip fractures ( i.e. , hip fracture ' equivalents ' ) and will provide a more comprehensive assessment of osteoporosis outcomes than is possible by focusing only on hip fractures Background Reverse obliquity fractures of the proximal femur have biomechanical characteristics distinct from other intertrochanteric fractures and high implant failure rate when treated with sliding hip screws . Intramedullary hip nailing for these fractures reportedly has less potential for cut-out of the lag screw because of their loadbearing capacity when compared with extramedullary implants . However , it is unclear whether nail length influences healing . Questions / purpose sWe compared st and ard and long types of intramedullary hip nails in terms of ( 1 ) reoperation ( fixation failure ) , ( 2 ) 1-year mortality rate , ( 3 ) function and mobility , and ( 4 ) union rate . Methods We conducted a pilot prospect i ve r and omized controlled trial comparing st and ard versus long ( ≥ 34 cm ) intramedullary hip nails for reverse obliquity fractures of the proximal femur from January 2009 to December 2009 . There were 15 patients with st and ard nails and 18 with long nails . Mean age was 79 years ( range , 67–95 years ) . We determined 1-year mortality rates , reoperation rates , Parker-Palmer mobility and Harris hip scores , and radiographic findings ( fracture union , blade cut-out , tip-apex distance , implant failure ) . Minimum followup was 12 months ( mean , 14 months ; range , 12–20 months ) . Results We found no difference in reoperation rates between groups . Two patients ( both from the long-nail group ) underwent revision surgery because of implant failure in one and deep infection in the other . There was no difference between the st and ard- and long-nail groups in mortality rate ( 17 % versus 18 % ) , Parker-Palmer mobility score ( five versus six ) , Harris hip score ( 74 versus 79 ) , union rate ( 100 % in both groups ) , blade cut-out ( zero versus one ) , and tip-apex distance ( 22 versus 24 mm ) . Conclusions Our preliminary data suggest reverse obliquity fractures of the trochanteric region of the femur can be treated with either st and ard or long intramedullary nails . Level of Evidence Level II , therapeutic study . See Instructions for Authors for a complete description of levels of evidence 
    Output:
    
When used to treat intertrochanteric femur fractures , LIN did not decrease the secondary femoral shaft refracture or reoperation rates .
LIN may not be a better method or provide more effective treatment for intertrochanteric femur fractures ; the LIN patients demonstrated the same prognosis as the SIN patients , particularly in terms of secondary femoral shaft refracture and reoperation rate , but they experienced greater trauma .