Treatment for displaced intracapsular fracture of the proximal femur : A prospective, randomised trial in patients aged 65 to 79 years

• Published in: Journal of bone and joint surgery. British volume Vol. 83; no. 2; pp. 206 - 212
• Main Authors: DAVISON, J. N. S, CALDER, S. J, ANDERSON, G. H, WARD, G, JAGGER, C, HARPER, W. M, GREGG, P. J
• Format: Journal Article
• Language: English
• Published: London British Editorial Society of Bone and Joint Surgery 01-03-2001
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Femoral Fractures - mortality; Femoral Fractures - surgery; Fracture Fixation - methods; Fracture Fixation, Internal; Humans; Medical sciences; Orthopedic surgery; Prospective Studies; Reoperation; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; Human; Femur; Prognosis; Femoral head; Prosthesis; Diseases of the osteoarticular system; Internal; Lower limb; Osteosynthesis; Fracture; Upper extremity; Trauma; Fragment; Joint capsule; Displacement; Hip; Orthopedic surgery; Fixation; Treatment; Bone; Technique; Elderly; Comparative study
• ISSN: 0301-620X; 2044-5377
• DOI: 10.1302/0301-620X.83B2.11128

We performed a prospective, randomised trial comparing three treatments for displaced intracapsular fractures of the hip in 280 patients aged 65 to 79 years. The mean patient survival was significantly higher in the group undergoing reduction and internal fixation (79 months) compared with that with a cemented Thompson hemiarthroplasty or a cemented Monk bipolar hemiarthroplasty (61 months and 68 months, respectively). After three years, 32 of 93 patients (34.4%) who had undergone fixation had local complications, necessitating further intervention in 28 (30%). There were no significant differences in the functional outcome in survivors, who were reviewed annually to five years. Either reduction and internal fixation or cemented hemiarthroplasty may be offered as alternative treatments for a displaced intracapsular fracture in a mobile and mentally competent patient under the age of 80 years. The choice of procedure by the patient and the surgeon should be determined by the realisation that the use of internal fixation is associated with a 30% risk of failure requiring further surgery. If this is accepted, however, hemiarthroplasty is avoided, which, in our study has a significantly shorter mean survival time. The use of a bipolar prosthesis has no significant advantage.