human
***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: INTRODUCTION The Danish Fracture Data base ( DFDB ) was established in 2011 to establish nationwide prospect i ve quality assessment of all fracture-related surgery . In this paper , we describe the DFDB 's setup , present preliminary data from the first annual report and discuss its future potential . MATERIAL AND METHODS The DFDB collaboration includes 13 hospitals and covers a population of 3.7 million .  Data registration is performed online by the surgeon following surgery , and it includes patient- , trauma- and surgery-related data . Primary procedures , reoperations and planned secondary procedures are registered . Indication for reoperation is also recorded . The reoperation rate and the one-year mortality are the primary indicators of quality . RESULTS Approximately 10,000 fracture-related surgical procedures were registered in the data base at the time of presentation of the first annual DFDB report ( currently 15,000 ) . 85 % of all procedures were performed on adult fractures and 15 % on paediatric fractures . Proximal femur ( 33 % ) , distal radius ( 15 % ) and malleolar fractures ( 12 % ) were the three most common primary adult fractures . Pain and discomfort from orthopaedic hardware , infection and failure of osteo synthesis were the three most common indications for reoperation and accounted for 34 % , 14 % and 13 % , respectively . CONCLUSION The DFDB is an online data base for registration of fracture-related surgery that allows for basic quality assessment of surgical fracture treatment and large-scale observational research by registering primary surgery , reoperations and planned secondary procedures . FUNDING not relevant . TRIAL REGISTRATION not relevant 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 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 Background Trochanteric fractures are common fractures in the elderly . Due to characteristic demographic changes , the incidence of these injuries is rapidly increasing . Treatment of these fractures is associated with high rates of complications . In addition , the long-term results remain poor , with high morbidity , declines in function , and high mortality . Therefore , in this study , complication rates and patients ’ outcomes were evaluated after fixation of geriatric trochanteric fractures using the Gamma3 ™ nail . Methods Patients aged 60 years old or older , with pertrochanteric and subtrochanteric femoral fractures , were included . Patients with polytrauma or pathological fractures were excluded . Age , sex , and fracture type were collected on admission . In addition , data were recorded concerning the surgeon ( resident vs. consultant ) , time of operation , and local or systemic perioperative complications . Complications were also collected at the 6- and 12-month follow-ups after trauma . Barthel Index , IADL , and EQ-5D measurements were evaluated retrospectively on admission , as well as at discharge and during the follow-up . Results Ninety patients were prospect ively included between April 2009 and September 2010 . The patients ’ average age was 81 years old , and their average ASA score was 3 . The incision/suture time was 53 min ( 95 % CI 46–60 min ) . Hospital mortality was 4 % , and overall mortality was 22 % at the 12-month follow-up . Eight local complications occurred ( 4 haematomas , 1 deep infection , 1 cutting out , 1 irritation of the iliotibial tract , 1 periosteosynthetic fracture ) . The incidence of relevant systemic complications was 6 % . Forty-two percent of the patients were operated on by residents in training , without significant differences in duration of surgery , complication rate , or mortality rate . The Barthel Index ( 82 to 71 , p < .001 ) , IADL ( 4.5 to 4.3 , p = .0195 ) and EQ-5-D ( 0.75 to 0.66 , p = .068 ) values did not reach pre-fracture levels during the follow-up period of 12 months . Conclusion The results showed a relatively low complication rate  using the Gamma3 ™ nail , even if the nailing was performed by residents in training .  The high mortality , declines in function , and low quality of life could probably be attributed to pre-existing conditions , such as physical status . In summary , the Gamma3 ™ nail seems to be a useful implant for the nailing of trochanteric fractures , although further studies are necessary comparing different currently available devices This study is a r and omized prospect i ve study comparing two fracture fixation implants , the extramedullary sliding hip screw ( SHS ) and the dual lag screw cephalomedullary nail , in the treatment of intertrochanteric femoral fractures in the elderly . One hundred and sixty-five patients with low-energy intertrochanteric fractures , classified as AO/OTA 31A , were prospect ively included during a 2-year period ( 2005–2006 ) . Patients were r and omized into two groups : group A included 79 hip fractures managed with sliding hip screws and group B included 86 fractures treated with cephalomedullary nails .  Delay to surgery , duration of surgery , time of fluoroscopy , total hospital stay , implant-related complications , transfusion requirements , re-operation details , functional recovery , and mortality were recorded . The mean follow-up was 36 months ( 24–56 months ) . The mean surgical time was statistically significantly shorter and fluoroscopy time longer for the group B. No intraoperative femoral shaft fractures occurred . There was no statistically significant difference in the functional recovery score , reoperation , and mortality rates between the 2 groups . A new type of complication , the so-called Z-effect phenomenon , was noticed in the cephalomedullary nail group . There are no statistically significant differences between the two techniques in terms of type and rate of complications , functional outcome , reoperation and mortality rates when comparing the SHS and the cephalomedullary nail for low-energy AO/OTA 31A intertrochanteric fractures . Our data do not support recommendations for the use of one implant over the other We analysed the time-dependent mean changes in the femoral neck length , neck-shaft angle and hip offset in a r and omised study comprising 48 patients who were treated with the dynamic hip screw ( DHS ) or the proximal femoral nail ( PFN ) for an unstable intertrochanteric femoral fracture . As a consequence of fracture compression , the mean post-operative neck length was significantly shorter in patients treated with the DHS . During the first 6 weeks after the operation , a mean decrease of 4.6 ° was observed in the neck-shaft angle , but there was not a significant difference between the treatment groups . The radiographic measures remained virtually unaffected during the interval from 6 weeks to 4 months in both groups . When the operated hip was compared to the opposite hip , patients who had received the DHS showed significantly greater medialisation of the femoral shaft at 4 months than those treated with the PFN . We thus recommend that unstable intertrochanteric fractures should be initially reduced in a slight valgus position in order to achieve an outcome after healing that is as normal as possible . As a result of differences in operative technique and implant stability , the PFN may be superior to the DHS in retaining the anatomical relations in the hip region in unstable intertrochanteric fractures . RésuméNous avons analysé les modifications , en fonction du temps , des valeurs moyennes de la longueur du col fémoral , de l’angle cervico-diaphysaire et du bras de levier de la hanche dans une étude r and omisée qui comprenait 48 malades traités avec une Vis Dynamique ( DHS )  ou un Clou Fémoral Proximal ( PFN ) aprés une fracture intertrochantérienne instable . Par suite de la compression de la fracture , la longueur du col était nettement plus courte chez les malades traités avec une DHS . Pendant les premières six semaines après l’opération , une baisse moyenne de 4.6 ° de l’angle cervico-diaphysaire a été observée mais il n’y avait pas de différence notable entre les groupes de traitement . Les mesures radiographiques sont restées pratiquement non affectées pendant l’intervalle de six semaines à quatre mois dans les deux groupes . Comparé à la hanche opposée , les malades qui avaient reçu une DHS ont montré à 4 mois une nettement plus gr and e médialisation de la diaphyse que ceux traités avec le PFN . Nous recomm and ons que ces fractures intertrochantériennes instables soient réduites en léger valgus pour avoir une situation aussi normale que possible après consolidation . Par suite de différences dans la technique opératoire et dans la stabilité de l’implant , le PFN semble supérieur au DHS pour rétablir l’anatomie de la région de la hanche dans les fractures intertrochantériennes instables The purpose of our study was to compare the proximal femoral nail antirotation ( PFNA ; Synthes , Paoli , Pennsylvania ) with a reconstruction nail ( Recon ; Zimmer , Warsaw , Indiana ) in the treatment of comminuted proximal femoral fractures . Between 2003 and 2010 , twenty-three consecutive patients with AO/Orthopaedic Trauma Association 31-A3 fractures combined with proximal 32 fractures who had a minimum 18-month follow-up were evaluated retrospectively . There were 10 patients ( age range , 18 - 74 years ) in the Recon nail group and 13 patients ( age range , 22 - 90 years ) in the PFNA nail group . Patients treated with Recon nails experienced a longer operation time ( P=.006 ) and more blood loss ( P=.012 ) than patients treated with the PFNA nail . On postoperative radiographs , the change in the neck-shaft angle was 8.8 ° in the Recon nail group and 4.7 ° in the PFNA nail group ( P=.048 ) . The fracture union time averaged 31.8 weeks in the Recon nail group and 21.5 weeks in the PFNA nail group ( P=.148 ) . More patients in the Recon nail group underwent major or minor reoperation ( P=.038 ) compared with the PFNA nail group . No implant failure occurred in either group . The functional results were similar in the 
    Output:
    
agent
The clinical evidence behind the current implants used for proximal femoral fractures is weak considering the number of implants used worldwide .
Sporadic evaluation is not sufficient to identify long term problems .
***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: INTRODUCTION The Danish Fracture Data base ( DFDB ) was established in 2011 to establish nationwide prospect i ve quality assessment of all fracture-related surgery . In this paper , we describe the DFDB 's setup , present preliminary data from the first annual report and discuss its future potential . MATERIAL AND METHODS The DFDB collaboration includes 13 hospitals and covers a population of 3.7 million .  Data registration is performed online by the surgeon following surgery , and it includes patient- , trauma- and surgery-related data . Primary procedures , reoperations and planned secondary procedures are registered . Indication for reoperation is also recorded . The reoperation rate and the one-year mortality are the primary indicators of quality . RESULTS Approximately 10,000 fracture-related surgical procedures were registered in the data base at the time of presentation of the first annual DFDB report ( currently 15,000 ) . 85 % of all procedures were performed on adult fractures and 15 % on paediatric fractures . Proximal femur ( 33 % ) , distal radius ( 15 % ) and malleolar fractures ( 12 % ) were the three most common primary adult fractures . Pain and discomfort from orthopaedic hardware , infection and failure of osteo synthesis were the three most common indications for reoperation and accounted for 34 % , 14 % and 13 % , respectively . CONCLUSION The DFDB is an online data base for registration of fracture-related surgery that allows for basic quality assessment of surgical fracture treatment and large-scale observational research by registering primary surgery , reoperations and planned secondary procedures . FUNDING not relevant . TRIAL REGISTRATION not relevant 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 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 Background Trochanteric fractures are common fractures in the elderly . Due to characteristic demographic changes , the incidence of these injuries is rapidly increasing . Treatment of these fractures is associated with high rates of complications . In addition , the long-term results remain poor , with high morbidity , declines in function , and high mortality . Therefore , in this study , complication rates and patients ’ outcomes were evaluated after fixation of geriatric trochanteric fractures using the Gamma3 ™ nail . Methods Patients aged 60 years old or older , with pertrochanteric and subtrochanteric femoral fractures , were included . Patients with polytrauma or pathological fractures were excluded . Age , sex , and fracture type were collected on admission . In addition , data were recorded concerning the surgeon ( resident vs. consultant ) , time of operation , and local or systemic perioperative complications . Complications were also collected at the 6- and 12-month follow-ups after trauma . Barthel Index , IADL , and EQ-5D measurements were evaluated retrospectively on admission , as well as at discharge and during the follow-up . Results Ninety patients were prospect ively included between April 2009 and September 2010 . The patients ’ average age was 81 years old , and their average ASA score was 3 . The incision/suture time was 53 min ( 95 % CI 46–60 min ) . Hospital mortality was 4 % , and overall mortality was 22 % at the 12-month follow-up . Eight local complications occurred ( 4 haematomas , 1 deep infection , 1 cutting out , 1 irritation of the iliotibial tract , 1 periosteosynthetic fracture ) . The incidence of relevant systemic complications was 6 % . Forty-two percent of the patients were operated on by residents in training , without significant differences in duration of surgery , complication rate , or mortality rate . The Barthel Index ( 82 to 71 , p < .001 ) , IADL ( 4.5 to 4.3 , p = .0195 ) and EQ-5-D ( 0.75 to 0.66 , p = .068 ) values did not reach pre-fracture levels during the follow-up period of 12 months . Conclusion The results showed a relatively low complication rate  using the Gamma3 ™ nail , even if the nailing was performed by residents in training .  The high mortality , declines in function , and low quality of life could probably be attributed to pre-existing conditions , such as physical status . In summary , the Gamma3 ™ nail seems to be a useful implant for the nailing of trochanteric fractures , although further studies are necessary comparing different currently available devices This study is a r and omized prospect i ve study comparing two fracture fixation implants , the extramedullary sliding hip screw ( SHS ) and the dual lag screw cephalomedullary nail , in the treatment of intertrochanteric femoral fractures in the elderly . One hundred and sixty-five patients with low-energy intertrochanteric fractures , classified as AO/OTA 31A , were prospect ively included during a 2-year period ( 2005–2006 ) . Patients were r and omized into two groups : group A included 79 hip fractures managed with sliding hip screws and group B included 86 fractures treated with cephalomedullary nails .  Delay to surgery , duration of surgery , time of fluoroscopy , total hospital stay , implant-related complications , transfusion requirements , re-operation details , functional recovery , and mortality were recorded . The mean follow-up was 36 months ( 24–56 months ) . The mean surgical time was statistically significantly shorter and fluoroscopy time longer for the group B. No intraoperative femoral shaft fractures occurred . There was no statistically significant difference in the functional recovery score , reoperation , and mortality rates between the 2 groups . A new type of complication , the so-called Z-effect phenomenon , was noticed in the cephalomedullary nail group . There are no statistically significant differences between the two techniques in terms of type and rate of complications , functional outcome , reoperation and mortality rates when comparing the SHS and the cephalomedullary nail for low-energy AO/OTA 31A intertrochanteric fractures . Our data do not support recommendations for the use of one implant over the other We analysed the time-dependent mean changes in the femoral neck length , neck-shaft angle and hip offset in a r and omised study comprising 48 patients who were treated with the dynamic hip screw ( DHS ) or the proximal femoral nail ( PFN ) for an unstable intertrochanteric femoral fracture . As a consequence of fracture compression , the mean post-operative neck length was significantly shorter in patients treated with the DHS . During the first 6 weeks after the operation , a mean decrease of 4.6 ° was observed in the neck-shaft angle , but there was not a significant difference between the treatment groups . The radiographic measures remained virtually unaffected during the interval from 6 weeks to 4 months in both groups . When the operated hip was compared to the opposite hip , patients who had received the DHS showed significantly greater medialisation of the femoral shaft at 4 months than those treated with the PFN . We thus recommend that unstable intertrochanteric fractures should be initially reduced in a slight valgus position in order to achieve an outcome after healing that is as normal as possible . As a result of differences in operative technique and implant stability , the PFN may be superior to the DHS in retaining the anatomical relations in the hip region in unstable intertrochanteric fractures . RésuméNous avons analysé les modifications , en fonction du temps , des valeurs moyennes de la longueur du col fémoral , de l’angle cervico-diaphysaire et du bras de levier de la hanche dans une étude r and omisée qui comprenait 48 malades traités avec une Vis Dynamique ( DHS )  ou un Clou Fémoral Proximal ( PFN ) aprés une fracture intertrochantérienne instable . Par suite de la compression de la fracture , la longueur du col était nettement plus courte chez les malades traités avec une DHS . Pendant les premières six semaines après l’opération , une baisse moyenne de 4.6 ° de l’angle cervico-diaphysaire a été observée mais il n’y avait pas de différence notable entre les groupes de traitement . Les mesures radiographiques sont restées pratiquement non affectées pendant l’intervalle de six semaines à quatre mois dans les deux groupes . Comparé à la hanche opposée , les malades qui avaient reçu une DHS ont montré à 4 mois une nettement plus gr and e médialisation de la diaphyse que ceux traités avec le PFN . Nous recomm and ons que ces fractures intertrochantériennes instables soient réduites en léger valgus pour avoir une situation aussi normale que possible après consolidation . Par suite de différences dans la technique opératoire et dans la stabilité de l’implant , le PFN semble supérieur au DHS pour rétablir l’anatomie de la région de la hanche dans les fractures intertrochantériennes instables The purpose of our study was to compare the proximal femoral nail antirotation ( PFNA ; Synthes , Paoli , Pennsylvania ) with a reconstruction nail ( Recon ; Zimmer , Warsaw , Indiana ) in the treatment of comminuted proximal femoral fractures . Between 2003 and 2010 , twenty-three consecutive patients with AO/Orthopaedic Trauma Association 31-A3 fractures combined with proximal 32 fractures who had a minimum 18-month follow-up were evaluated retrospectively . There were 10 patients ( age range , 18 - 74 years ) in the Recon nail group and 13 patients ( age range , 22 - 90 years ) in the PFNA nail group . Patients treated with Recon nails experienced a longer operation time ( P=.006 ) and more blood loss ( P=.012 ) than patients treated with the PFNA nail . On postoperative radiographs , the change in the neck-shaft angle was 8.8 ° in the Recon nail group and 4.7 ° in the PFNA nail group ( P=.048 ) . The fracture union time averaged 31.8 weeks in the Recon nail group and 21.5 weeks in the PFNA nail group ( P=.148 ) . More patients in the Recon nail group underwent major or minor reoperation ( P=.038 ) compared with the PFNA nail group . No implant failure occurred in either group . The functional results were similar in the 
    Output:
    