Treatment for displaced intracapsular fracture of the proximal femur

Abstract

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.

Interventions for treating displaced intracapsular femoral neck fractures in the elderly: a Bayesian network meta-analysis of randomized controlled trials

“…A total of 6141 patients with femoral neck fractures were included in the meta-analysis; of these, the treatment breakdown included 1432, 1194, 821, 1511, 252, 229, and 702 in the IF, unipolar cemented HA, unipolar uncemented HA, bipolar cemented HA, bipolar uncemented HA, uncemented THR, and cemented THR groups, respectively. Five studies 32,36,43,50,51 contained 3 arms; however, the remainder were 2-arm studies. In the IF group, cancellous lag screws or sliding hip screw (with or without antirotational screws) were used.…”

Arthroplasty versus Internal Fixation for Displaced Intracapsular Femoral Neck Fracture in the Elderly

“…After assessing the 23 potentially relevant articles, eight RCTs involving 2206 patients met the inclusion criteria. [2223242526272829] The primary reasons for exclusion were as follows: six were review articles,[113031323334] six reported data that did not pertain to intracapsular hip fractures,[31535363738] one was a correspondence letter,[39] and two studies were excluded because they were not RCTs. [4041] Details of the selection process are shown in Figure 1.…”

“…Five studies compared HA with IF,[2324262729] two studies compared both THA and HA with IF,[2225] and one study compared THA and IF. [28] The mean length of follow-up ranged from 1 to 17 years.…”

“…The reasons, we suggest, may be largely related to the high incidence of avascular necrosis, nonunion, and mechanical failure of implants following IF. [2223242526272829] Attempting to minimize the influence of different descriptions of pain across studies, the analyses only documented the number of patients with persistent pain; results based on different scoring systems were not pooled.…”

Fixation using alternative implants for the treatment of hip fractures (FAITH): design and rationale for a multi-centre randomized trial comparing sliding hip screws and cancellous screws on revision surgery rates and quality of life in the treatment of femoral neck fractures

“…Although nonunion and avascular necrosis may be present after 24 months, previous studies suggest that 70-98% of revisions due to nonunion and avascular necrosis occur within 24 months [30,31]. Thus, we can expect that nearly all the revision surgeries will occur within 24 months.…”