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The total costs of a displaced femoral neck fracture: comparison of internal fixation and total hip replacement

A randomised study of 146 hips

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Abstract

We randomised 143 patients –age 75 years or older–with displaced femoral neck fracture to either internal fixation or total hip replacement (THR) and compared the socio-economic consequences. In the internal fixation group, 34 of 78 hips underwent secondary surgery. In the THR group, 12 of 68 hips dislocated, the majority in mentally impaired patients. We calculated the total hospital costs for two years after operation. When secondary surgery was included, there was no difference in costs between the internal fixation and THR groups, or between the mentally impaired and lucid subgroups. The costs to the community were calculated comparing the baseline cost before surgery with the average cost per month during the first postoperative year. No difference was found between the treatment groups. The Harris hip scores were higher in the THR group, and pain was more common in the internal fixation group. In lucid patients, THR gives a better clinical result at the same cost.

Résumé

Nous avons randomisé 143 malades-âgés de 75 ans ou plus– avec une fracture du col fémoral déplacée traitée par fixation interne ou remplacement totale de la hanche et avons comparé les conséquences socio-économiques. Dans le groupe de la fixation interne, 34/78 hanches ont subi une chirurgie secondaire. Dans le groupe PTH, 12/68 hanches se sont luxées, la majorité chez des malades mentalement affaiblis. Nous avons calculé les coûts totaux d’hospitalisation jusqu’à deux années postopératoires. Quand la chirurgie secondaire a été incluse, il n’y avait aucune différence dans les coûts entre la fixation interne et le groupe PTH, ou entre les sous-groupes mentalement affaibli et lucides. Les coûts municipaux ont été calculés en comparant le coût de base avant chirurgie avec le coût moyen par mois pendant la première année postopératoire. Aucune différence n’a été trouvée entre les groupes de traitement. Le score de hanche de Harris étaient supérieur dans le groupe PTH et la douleur était plus fréquente dans le groupe de la fixation interne. Chez les malades lucides, la PTH donne un meilleur résultat clinique au même coût.

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Authors and Affiliations

  1. Department of Neuroscience and Locomotion, Division of Orthopaedics and Sports Medicine, University Hospital, Linköping, Sweden

    Torsten Johansson, Per Aspenberg & Ola Wahlström

  2. Department of Medicine and Care, Division of Nursing Science, University Hospital, Linköping, Sweden

    Margareta Bachrach-Lindström

  3. Center for Medical Technology Assessment (CMT), Department of Health and Environment, Faculty of Health Sciences, University Hospital, Linköping, Sweden

    Dick Jonsson

Authors
  1. Torsten Johansson
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  2. Margareta Bachrach-Lindström
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  3. Per Aspenberg
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  4. Dick Jonsson
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  5. Ola Wahlström
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Correspondence to Torsten Johansson.

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Johansson, T., Bachrach-Lindström, M., Aspenberg, P. et al. The total costs of a displaced femoral neck fracture: comparison of internal fixation and total hip replacement. International Orthopaedics (SICO 30, 1–6 (2006). https://doi.org/10.1007/s00264-005-0037-z

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  • DOI: https://doi.org/10.1007/s00264-005-0037-z

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