In a prospective randomised trial, 455 patients presenting to one hospital with a displaced intracapsular fracture were randomised to either closed reduction and internal fixation with three cancellous screws or replacement with an uncemented hemiarthroplasty. Follow-up of surviving patients was for between 9 and 15 years to determine the long-term outcome for the two treatment methods. 93% of patients died during this follow-up period. There was no difference in mortality between the two procedures. The need for revision surgery to the hip was increased for those treated by internal fixation (93% versus 62% implant survival rate; hazard ratio: 0.14, 95% CI 0.08–0.24). 91% of revision's operations occurred within 2 years from injury. There was no difference in the degree of residual pain between groups neither was there any difference in the number of patients requiring institutional care. These results demonstrate that both treatment methods produce comparable final outcomes but internal fixation is associated with an increased re-operation rate.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Injury
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- The long-term results of low-friction arthroplasty of the hip performed as a primary intervention.J Bone Joint Surg [Br]. 1972; 54: 61-76
- A survey of the treatment of displaced intracapsular femoral neck fractures in the UK.Injury. 2002; 33: 383-386
- Treatment of femoral neck with total hip replacement versus cemented and noncemented hemiarthroplasty.J Arthroplasty. 1986; 1: 210-228
- Bipolar hemiarthroplasty for subcapital fracture of the femoral neck: a prospective randomised trial of cemented Thompson and uncemented Moore stems.J Bone Joint Surg. 1991; 73B: 322-324
- The unsolved fracture.J Bone Joint Surg [Br]. 1963; 45B: 239-241
- Internal fixation versus arthroplasty for intracapsular proximal femoral fractures in adults.Cochrane Rev (The Cochrane Library). 2006; ([Chichester: Wiley])
- Hemiarthroplasty versus internal fixation for displaced intracapsular hip fractures in the elderly: a randomised trial of 455 patients.J Bone Joint Surg [Br]. 2002; 84B: 1150-1155
- A new mobility score for predicting mortality after hip fracture.J Bone Joint Surg [Br]. 1993; 75B: 797-798
Accepted: October 2, 2009
© 2009 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.