Only one randomised trial of 90 patients with unstable extracapsular hip femoral fractures in the trochanteric region was identified and included in this review. This compared arthroplasty with a sliding hip screw and was of poor methodological quality. From the limited data available for this trial, there were no significant differences between the two methods of treatment for operating time, local wound complications, mortality rate or mobility or loss of independence of previously independent patients. There was however a higher blood transfusion need in the arthroplasty group.