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Treatment for displaced intracapsular fracture of the proximal femur

A PROSPECTIVE, RANDOMISED TRIAL IN PATIENTS AGED 65 TO 79 YEARS

Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK

S. J. Calder, MD, FRCS Orth, Consultant Orthopaedic Surgeon

Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK.

G. H. Anderson, FRCS Orth, Consultant Orthopaedic Surgeon

Derriford Hospital, Derriford, Plymouth PL6 8DH, UK.

G. Ward, MPhil, SROT, Occupational Therapist, Senior Lecturer in Occupational Therapy

School of Health and Social Sciences, Coventry University, Priory Street, Coventry CV1 5FB, UK.

C. Jagger, MD, Professor

Department of Public Health and Epidemiology

W. M. Harper, MD, FRCS Ed, Professor

Department of Orthopaedic Trauma, University of Leicester, Leicester LE1 7RH, UK.

P. J. Gregg, MD, FRCS, Professor

Department of Orthopaedics, University of Newcastle upon Tyne, Newcastle upon Tyne, UK.

Correspondence should be sent to Mr J. N. S. Davison.

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.