Internal Screw Fixation Compared with Bipolar Hemiarthroplasty for Treatment of Displaced Femoral Neck Fractures in Elderly Patients

Gjertsen, Jan‐Erik; Vinje, Tarjei; Engesæter, Lars B.; Lie, Stein Atle; Havelin, Leif Ivar; Furnes, Ove; Fevang, Jonas

doi:10.2106/jbjs.h.01750

Cited by 172 publications

(136 citation statements)

References 57 publications

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“…The Kaplan-Meier curves did not identify any differences in the two groups in patient survival either early on or in the present report at a minimum followup of 5 years. This has also been documented in registry studies [13]. Hemiarthroplasty may represent a heavier surgical burden for the patient compared with internal fixation, which may lead to increased early mortality.…”

Section: Discussionmentioning

confidence: 68%

“…The overall short life expectancy and the superior shortterm function in the hemiarthroplasty group reinforce bipolar hemiarthroplasty as the treatment of choice in elderly patients with a displaced intracapsular hip fracture [10,13,29,33]. The excess mortality compared with the background population is well demonstrated for the first year after fracture [20].…”

Section: Discussionmentioning

confidence: 91%

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Randomized Trial of Hemiarthroplasty versus Internal Fixation for Femoral Neck Fractures: No Differences at 6 Years

Støen

Lofthus

Nordsletten

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Hemiarthroplasty has been shown superior to internal fixation for displaced femoral neck fractures (FNF) in the first 2 years. However, there are unanswered questions about the performance of hemiarthroplasty over the longer term compared with internal fixation. Questions/purposes We sought to compare hemiarthroplasty with internal fixation in terms of (1) outcomes scores for pain, hip function, and quality of life at a minimum of 5 years after surgery in a randomized trial. A secondary purpose was to compare (2) patient survival and (3) frequency of reoperation in the two groups. Methods A total of 222 consecutive patients older than 60 years, including those cognitively impaired, with FNF were randomized to either internal fixation with two parallel screws or bipolar hemiarthroplasty. At a minimum followup of 4.9 years (mean, 5.9 years; range, 4.9-7.2 years), 68 of the 70 surviving patients were examined by a study nurse and study physiotherapist blinded to initial treatment. Questionnaires on hip function (Harris hip score), quality of life (Eq5D), and activity of daily living function (Barthel ADL) were administered. The Barthel ADL index score was split into good function (score 95 or 100) and reduced function (score below 95).

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 91%

Randomized Trial of Hemiarthroplasty versus Internal Fixation for Femoral Neck Fractures: No Differences at 6 Years

Støen

Lofthus

Nordsletten

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…Results of our multivariate Cox-regression analysis are in contrast to the vast majority of trails [8][9][10][11][16][17][18]26] . Several studies reported higher one year mortality rates for HA than IF [18,26,27] .…”

Section: Discussionmentioning

confidence: 99%

“…This is confirmed by Frihagen et al [8] who also identified approximately one third of femoral neck fracture patients suffering from cognitive impairment. Another factor potentially influencing mortality which is time to surgery or patients referred to surgery beyond 48 h are not addressed in all recent randomised and nonrandomised trials [8][9][10][11][16][17][18][32][33][34] . In our study timing of surgery was associated with significantly higher one year mortality.…”

Section: Discussionmentioning

confidence: 99%

“…Beyond study design, the time period of patient recruitment should be considered which in most of the studies comparing IF with cemented HA date back almost 10 years or even longer [8][9][10][11][16][17][18] . This is of importance, since Schneppendahl and colleagues [19] reported a decreasing mortality after femoral neck fractures treated with bipolar HA over the last twenty years with the most pronounced effect seen after 2006.…”

Section: Influence Of Internal Fixation and Cemented Hemiarthroplastymentioning

confidence: 99%

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Influence of Internal Fixation and Cemented Hemiarthroplasty on 1-Year Mortality in Geriatric Hip Fracture Patients

Fakler

Gräfe

Dercks

et al. 2017

International Journal of Orthopaedics

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AIM:Results after cemented Hemiarthoplasty (HA) in elderly patients with a femoral neck fracture improved over the last 20 years. We conducted this study in order to evaluate the influence of modern cemented HA compared to IF with a sliding hip screw (SHS) with regard to one year mortality. PATIENTS AND METHODS: 183 patients with a low-energy medial femoral neck fracture (AO/OTA 31-B) either treated with a SHS (n = 67) or cemented HA (n = 116) were included. Follow-up was performed at 6 and 12 months. A multivariate Cox regression analysis including nine confounding variables (age, ASA score, body mass index (BMI), cognitive function, time from admission to surgery, creatinine, c-reactive protein (CRP), 25-hydroxyvitamin D (25(OH)D) was performed. RESULTS: Patients in the HA group were significantly older (p < 0.001) and had more severe comorbidities according to the ASAScore (p = 0.017). The time interval from admission to surgery (skin incision) was beyond 48h in 6.0% of SHS patients and 17.2% in HA patients (p < 0.001). Despite of detrimental prerequisites for cemented HA, mortality rates at 1 year for HA (23.3%) showed no significant difference (p = 0.58) to IF (19.4%). After correcting for confounding variables mortality risk at one year was significantly higher in patients treated with a SHS (HR = 2.5, 95%CI 1.1-5.7; p = 0.027). CONCLUSION: We conclude that elderly patients with a femoral neck fracture might benefit from cemented HA compared to IF with a SHS in terms of 1-year mortality. New randomised controlled trials considering modern cementing techniques are needed to validate these results.

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Radiostereometric analysis of the initial stability of internally fixed femoral neck fractures under differential loading

Finnilä

Moritz

Strandberg

et al. 2018

Journal Orthopaedic Research

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We examined the feasibility of radiostereometric analysis (RSA) in the assessment of the initial stability of internally fixed femoral neck fractures. The study included 16 patients (mean age 73 years). During surgery, multiple RSA‐beads were inserted on both sides of the fracture. Radiographs for RSA were taken in the supine position within the first 3 days and 6, 12, 24, and 52 weeks after surgery. To detect any inducible motion at the fracture‐site, radiographs for RSA were taken with the patient resting or applying a load through the fracture. Fracture loading was achieved by the patient pressing the ipsilateral foot as much as tolerated on a force plate while providing a counterforce through both hands. Micromotion exceeding the precision values of RSA (≥0.3 mm for the translation vector and/or ≥1.2 degrees for the rotation vector) was considered significant. Permanent three‐dimensional fracture‐site displacement was also recorded. Voluntary loading induced fracture‐site micromotion, which exhibited a dichotomous distribution. In patients with uncomplicated fracture union, inducible micromotion was detectable only at baseline—if at all. Conversely, fractures that developed a nonunion were characterized by the continuation of inducible micromotion beyond baseline. Permanent fracture‐site displacement was, on average, nearly an order of magnitude greater than the inducible micromotion. Fracture unions were characterized by the cessation of permanent fracture‐site displacement by 12 weeks. Nonunions presented as outliers in permanent fracture‐site displacement. Large‐scale studies are warranted to evaluate whether the detection of inducible micromotion beyond baseline could serve as an indicator of insufficient fixation stability. © 2018 The Authors. Journal of Orthopaedic Research ® Published by Wiley Periodicals, Inc. on behalf of the Orthopaedic Research Society.

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Internal Screw Fixation Compared with Bipolar Hemiarthroplasty for Treatment of Displaced Femoral Neck Fractures in Elderly Patients

Abstract: Displaced femoral neck fractures in the elderly should be treated with hemiarthroplasty.

Cited by 172 publications

References 57 publications

Randomized Trial of Hemiarthroplasty versus Internal Fixation for Femoral Neck Fractures: No Differences at 6 Years

Randomized Trial of Hemiarthroplasty versus Internal Fixation for Femoral Neck Fractures: No Differences at 6 Years

Influence of Internal Fixation and Cemented Hemiarthroplasty on 1-Year Mortality in Geriatric Hip Fracture Patients

Radiostereometric analysis of the initial stability of internally fixed femoral neck fractures under differential loading

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