This Article Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal My Folders Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Parker, M. J. Articles by Pryor, G. A. Search for Related Content PubMed PubMed Citation Articles by Parker, M. J. Articles by Pryor, G. A.

Hemiarthroplasty versus internal fixation for displaced intracapsular hip fractures in the elderly

A RANDOMISED TRIAL OF 455 PATIENTS M.

Peterborough District Hospital, Thorpe Road, Peterborough PE3 6DA, UK.

Correspondence should be sent to Mr M. J. Parker.

A total of 455 patients aged over 70 years with a displaced intracapsular fracture of the proximal femur was randomised to be treated either by hemiarthroplasty or internal fixation. The preoperative characteristics of the patients in both groups were similar.

Internal fixation has a shorter length of anaesthesia (36 minutes versus 57 minutes, p < 0.0001), lower operative blood loss (28 ml versus 177 ml, p < 0.0001) and lower transfusion requirements (0.04 units versus 0.39 units, p < 0.0001). In the internal fixation group 90 patients required 111 additional surgical procedures while only 15 additional operations on the hip were needed in 12 patients in the arthroplasty group. There was no statistically significant difference in mortality between the groups at one year (61/226 versus 63/229, p = 0.91), but there was a tendency for an improved survival in the older less mobile patients treated by internal fixation. For the survivors assessed at one, two and three years from injury there were no differences with regard to the outcome for pain and mobility. Limb shortening was more common after internal fixation (7.0 mm versus 3.6 mm, p = 0.004).

We recommend that displaced intracapsular fractures in the elderly should generally be treated by arthroplasty but that internal fixation may be appropriate for those who are very frail.

This article has been cited by other articles:

				R. Blomfeldt, H. Tornkvist, K. Eriksson, A. Soderqvist, S. Ponzer, and J. Tidermark A randomised controlled trial comparing bipolar hemiarthroplasty with total hip replacement for displaced intracapsular fractures of the femoral neck in elderly patients J Bone Joint Surg Br, February 1, 2007; 89-B(2): 160 - 165. [Abstract] [Full Text] [PDF]

				D. ABBAS Internal fixation versus hemiarthroplasty for displaced fractures of the femoral neck in elderly patients with severe cognitive impairment J Bone Joint Surg Br, December 1, 2005; 87-B(12): 1701 - 1701. [Full Text] [PDF]

				J. TIDERMARK Author's reply J Bone Joint Surg Br, December 1, 2005; 87-B(12): 1701 - 1702. [Full Text] [PDF]

				R. Blomfeldt, H. Tornkvist, S. Ponzer, A. Soderqvist, and J. Tidermark Internal fixation versus hemiarthroplasty for displaced fractures of the femoral neck in elderly patients with severe cognitive impairment J Bone Joint Surg Br, April 1, 2005; 87-B(4): 523 - 529. [Abstract] [Full Text] [PDF]

				M. J. Heetveld, E. L. F. B. Raaymakers, B. L. van Eck-Smit, A. D. P. van Walsum, and J. S. K. Luitse Internal fixation for displaced fractures of the femoral neck: DOES BONE DENSITY AFFECT CLINICAL OUTCOME? J Bone Joint Surg Br, March 1, 2005; 87-B(3): 367 - 373. [Abstract] [Full Text] [PDF]