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

Lookup NU author(s): Professor Carol Jagger, Professor Paul Gregg

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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.


Publication metadata

Author(s): Davison JNS, Calder SJ, Anderson GH, Ward G, Jagger C, Harper WM, Gregg PJ

Publication type: Article

Publication status: Published

Journal: Journal of Bone and Joint Surgery: British Volume

Year: 2001

Volume: 83B

Issue: 2

Pages: 206-212

ISSN (print): 0301-620X

ISSN (electronic): 2044-5377

Publisher: British Editorial Society of Bone and Joint Surgery


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