Uneven global distribution of randomized trials in hip fracture surgery

BACKGROUND AND PURPOSE Hip fractures are among the top causes of global disability. Conduction of high-quality studies such as randomized controlled trials to assess the effectiveness of interventions remains crucial. The geographic distribution of hip fracture studies is largely unknown. We wanted to make a global assessment of national contributions of randomized controlled trials on surgical interventions for hip fracture. METHODS We performed a systematic search for randomized controlled trials on surgical interventions for hip fracture that were published from May 1970 to May 2011. Study information including sample size and study location was abstracted. The number of trials and cumulative sample size of hip fracture clinical trials were analyzed with respect to geographic region (city, country, and continent). RESULTS We identified 199 randomized trials investigating surgical interventions. Sweden ranked highest with 50 trials (8,941 patients). The United Kingdom followed with 40 trials (7,589 patients). Other countries contributed substantially less. The United States and Canada together contributed only a tenth of the total number of trials contributed by European countries. INTERPRETATION Global contributions to randomized trials and the total number of patients recruited have been led by Scandinavian countries and the UK. Countries with few trials but a large burden of hip fractures have an opportunity to engage in high-quality research to resolve important surgical questions and improve the generalizability of study results.