• HRQL (SF-12,WOMAC,EQ-5D, Merle d'Aubigne (MDA), Parker Mobility score) [ Time Frame: hospital admission, 1 and 2 weeks, 3, 6, 9,12, 18 and 24 months ] [ Designated as safety issue: Yes ]
• Fracture healing rates [ Time Frame: 3, 6, 9,12, 18 and 24 months ] [ Designated as safety issue: No ]
• Complications (mortality, femoral shaft fracture, avn, nonunion, malunion, implant breakage/failure, infection) [ Time Frame: ospital admission, 1 and 2 weeks, 3, 6, 9,12, 18 and 24 months ] [ Designated as safety issue: Yes ]

The purpose of this study is to investigate whether Gamma3 intramedullary nails versus sliding hip screws will decrease the rate of revision surgeries at two years in patients with inter-trochanteric fractures of the hip. The investigators will also compare functional recovery, complications, and quality of life.

Hip Fractures are anatomically classified in relation to the hip capsule as intracapsular fractures (i.e., femoral neck) or extracapsular fractures (i.e., intertrochanteric and subtrochanteric). Approximately 50 percent of hip fractures compromise intertrochanteric fractures (extracapsular fractures). These extracapsular fractures occur in a line between the greater and lesser trochanters, generally in elderly patients and women secondary to osteoporosis.

This trial will focus on management options for inter-trochanteric fractures of the hip. Intertrochanteric fractures may be either stable (a single fracture line without displacement) or unstable (multiple fracture lines (comminution) with displacement). Patients who present with an intertrochanteric fracture may experience hip pain, decreased function and quality of life. The extremity appears shortened and significantly externally rotated. Operative treatment of extracapsular hip fractures was introduced in the 1950's using a variety of different implants. Orthopaedic surgeons agree that internal fixation is the standard for the management of intertrochanteric fractures. Implants may be either intramedullary or extramedullary. Two common devices include the Gamma nail (intramedullary) and the sliding hip screw (extramedullary). Both approaches have strong physiologic rationale and ardent advocates.

Complications of internal fixation of the intertrochanteric fracture include implant failures, infections, femoral shaft fractures, malunion, and nonunion of the bone. Over 20 percent of patients with an intertrochanteric fracture repaired with internal fixation experience a complication. These complications usually require a revision surgery and are associated with high morbidity and appreciable mortality. Even patients who do not require revision surgery may have long-term functional limitation and diminished quality of life due to soft tissue damage at the time of surgery.

In summary, while sliding hip screws have the advantage of reduced need for revision surgery (primarily the result of decreased risk of femoral shaft fracture) in most intertrochanteric fractures of the hip, the newer generation Gamma3 Nails (Gamma3) have strong rationale and early supportive data suggesting significantly decreased rates of femoral shaft fractures and improved function. The improvements in implant design provide compelling rationale for the conduct of a large, definitive trial.

• Femoral Neck Fractures
• Inter-Trochanteric Hip Fracture

• Procedure: Gamma3 intramedullary nail (Stryker)
• Procedure: Sliding Hip Screw

• Active Comparator: Gamma3 intramedullary nail
• Active Comparator: Sliding hip screw

Inclusion Criteria:

• Adult men or women aged 50 years and older (with no upper age limit).
• An intertrochanteric fracture (stable or unstable) confirmed with anterior and posterior lateral hip radiographs, computed tomography, or magnetic resonance imaging (MRI).
• Operative treatment within 3 days (i.e., 72 hours) after the trauma.
• Patient was ambulatory prior to fracture, though they may have used an aid such as a cane or a walker.
• Anticipated medical optimalization of the patient for operative fixation of the hip.
• Provision of informed consent by patient or proxy.
• Low energy fracture (defined as a fall from standing height).
• No other major trauma.

Exclusion Criteria:

• Associated major injuries of the lower extremity (i.e., ipsilateral or contralateral fractures of the foot, ankle, tibia, fibula, knee, or femur; dislocations of the ankle, knee, or hip; or femoral head defects or fracture).
• Retained hardware around the affected hip.
• Infection around the hip (i.e., soft tissue or bone).
• Patients with disorders of bone metabolism other than osteoporosis (i.e., Paget's disease,renal osteodystrophy, or osteomalacia).
• Moderate or severe cognitively impaired patients (i.e., Six Item Screener with three or more errors).
• Patients with Parkinson's disease (or dementia) severe enough to increase the likelihood of falling or severe enough to compromise rehabilitation.
• Likely problems, in the judgment of the investigators, with maintaining follow-up. The investigators will, for example, exclude patients with no fixed address, those who report a plan to move out of town in the next year, or intellectually challenged patients without adequate family support.
• If the attending surgeon believes that a patient should be excluded from REGAIN because the patient is enrolled in another ongoing drug or surgical intervention trial.
• If the attending surgeon believes that there is another reason to exclude this patient from REGAIN. This reason will be documented on the case report forms.