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Purpose. To compare closed intramedullary nailing to open reduction and internal fixation using a fixed angle blade plate for the management of subtrochanteric femoral fractures.Methods. 58 patients were equally randomised to undergo either an intramedullary nailing (IN) or fixed angle blade plating (BP).Results. There were no significant differences between the 2 groups with regard to age, time to surgery, operating time, receipt of blood transfusions, duration of hospital stay, or fracture classification. The revision rate was 28% (8/29) in the BP group and none in the IN group; the difference was statistically significant.Conclusion. Internal fixation using a fixed angle blade plate for subtrochanteric femoral fractures has higher implant failure and revision rates, compared to closed intramedullary nailing.

Purpose. To examine possible causes of publication bias in the orthopaedic literature so as to avoid inappropriate clinical decisions based on reviews of the literature.Methods. Two reviewers independently reviewed abstracts presented to the 1999 American Academy of Orthopaedic Surgeons annual meeting. Data pertaining to sample size, statistical significance, study setting, country of origin, outcome, study type, and sponsorship were extracted from each abstract. The publication rate was measured after 5 years, by electronic searching and author contact. Predictors of publication were identified using logistic regression analysis.Results. Of the 318 abstracts listed in the proceedings, 175 (55%) were published within 5 years. Publication was associated with positive rather than neutral outcomes (odds ratio, 1.62; 95% confidence interval, 1.01–2.59; p<0.05) and with the reporting of statistical significance (odds ratio, 2.05; 95% confidence interval 1.24–3.39; p=0.005). Sponsorship, country of origin, sample size, study setting, and study type did not significantly influence the publication rate.Conclusion. Evidence of publication bias exists in abstracts presented at the 1999 American Academy of Orthopaedic Surgeons annual meeting. Clinical decisions based on the literature may be biased due to an over-representation of studies with positive outcomes.

Purpose. To compare the complication rates associated with orthopaedic trauma surgery performed by unsupervised and supervised trainees.Methods. In our hospital, 6361 orthopaedic trauma operations were performed between 1 January 1998 and 31 December 2002. Data pertinent to the surgeon's supervision and postoperative complications were collected. Elective operations were excluded, as consultants were almost always present. Complication rates ensuing in unsupervised and supervised groups were compared using the Chi squared test.Results. Of 6361 orthopaedic trauma operations performed, 3754 (59%) were by unsupervised trainees of varying experience, whereas 2494 (39%) were by supervised trainees or consultants. In 113 (2%) of the operations, the supervision status was not recorded. The complication rate was significantly higher in the supervised than unsupervised group (5.3 vs 3.3%, ?2=15, df=1, p=0.0001).Conclusion. The complication rate was not higher for operations performed by unsupervised trainees than those performed in the presence of a consultant.