Abstract
Introduction
There were higher rates of revision, complication, non-union, delayed union, and poorer functional outcomes reported in super-aged patients of undisplaced femoral neck fractures treated with internal fixation. Therefore, we designed this randomized comparative study aiming to compare the effectiveness and long-term follow-up results of hemiarthroplasty (HA) with that of multiple cannulated screws (MCS).
Materials and methods
Eligible participants were randomly assigned into two groups for different methods of operation (hemiarthroplasty group and internal fixation group). The related indexes and data of two groups were collected for comparative analysis during the average follow-up period of 38.68 ± 28.24 months.
Results
There were only two patients performed reoperation in HA group, and the reoperation rate of HA group (5.41%, 2/37) was significantly lower than that of IF group (21.4%, 9/41) (P value = 0.000). The comparison of survival curves for reoperation showed significant differences between two groups (P value = 0.031).The results of Cox proportional hazards model suggested that only operation method significantly affected the occurrence of reoperation (P value = 0.049). The results of survival analysis showed that there was no significant difference in survival time between two groups (P value = 0.682). And in the Cox proportional hazards model, only age significantly affected the occurrence of death (P value = 0.000). The average Harris scores of two groups were all above 75 points, and there was no significant difference in Harris scores between the two groups (P value greater than 0.05). But in the early term follow-up, the excellent and good rate of hip joint function in HA group was significantly higher than that in IF group (P value less than 0.05).
Conclusions
Hemiarthroplasty with less postoperative complications, low reoperation rate and better function recovery in early stage provide a good choice for the treatment of super-aged patients with nondisplaced femoral neck fracture.
Similar content being viewed by others
References
Cooper C, Campion G, Melton LJ 3rd (1992) Hip fractures in the elderly: a world-wide projection. Osteoporos Int 2(6):285–289 (PMID: 1421796)
Thorngren KG, Hommel A, Norrman PO, Thorngren J, Wingstrand H (2002) Epidemiology of femoral neck fractures. Injury. 33(Suppl 3):C1–C7 (PMID: 12423584)
Manohara R, Liang S, Huang D, Krishna L (2014) Cancellous screw fixation for undisplaced femoral neck fractures in the elderly. J Orthop Surg (Hong Kong) 22(3):282–286 (PMID: 25550003)
Lee YS, Chen SH, Tsuang YH, Huang HL, Lo TY, Huang CR (2008) Internal fixation of undisplaced femoral neck fractures in the elderly: a retrospective comparison of fixation methods. J Trauma 64(1):155–162. doi:10.1097/TA.0b013e31802c821c (PMID: 18188115)
Chen WC, Yu SW, Tseng IC, Su JY, Tu YK, Chen WJ (2005) Treatment of undisplaced femoral neck fractures in the elderly. J Trauma 58(5):1035–1039 (discussion 1039, PMID:15920421)
Yih-Shiunn L, Chien-Rae H, Wen-Yun L (2007) Surgical treatment of undisplaced femoral neck fractures in the elderly. Int Orthop 31(5):677–682. doi:10.1007/s00264-006-0243-3 (Epub 2006 Oct 11, PMID:17033764, PMCID:PMC2266644)
Eisler J, Cornwall R, Strauss E, Koval K, Siu A, Gilbert M (2002) Outcomes of elderly patients with nondisplaced femoral neck fractures. Clin Orthop Relat Res 399:52–58 (PMID: 12011694)
Kim JW, Byun SE, Chang JS (2014) The clinical outcomes of early internal fixation for undisplaced femoral neck fractures and early full weight-bearing in elderly patients. Arch Orthop Trauma Surg 134(7):941–946. doi:10.1007/s00402-014-2003-y (Epub 2014 May 8, PMID: 24806536)
Palm H, Gosvig K, Krasheninnikoff M, Jacobsen S, Gebuhr P (2009) A new measurement for posterior tilt predicts reoperation in undisplaced femoral neck fractures: 113 consecutive patients treated by internal fixation and followed for 1 year. Acta Orthop 80(3):303–307. doi:10.3109/17453670902967281 (PMID: 19634021)
Warschawski Y, Sharfman ZT, Berger O, Steinberg EL, Amar E, Snir N (2016) Dynamic locking plate vs. simple cannulated screws for nondisplaced intracapsular hip fracture: a comparative study. Injury 47(2):424–427. doi:10.1016/j.injury.10.054 (Epub 2015 Oct 30, PMID: 26612475)
Chiu FY, Lo WH (1996) Undisplaced femoral neck fracture in the elderly. Arch Orthop Trauma Surg 115(2):90–93 PMID:9063859
Conn KS, Parker MJ (2004) Undisplaced intracapsular hip fractures: results of internal fixation in 375 patients. Clin Orthop Relat Res 421:249–254 (PMID: 15123955)
Hui AC, Anderson GH, Choudhry R, Boyle J, Gregg PJ (1994) Internal fixation or hemiarthroplasty for undisplaced fractures of the femoral neck in octogenarians. J Bone Joint Surg Br 76(6):891–894 (PMID: 7983113)
Rogmark C, Flensburg L, Fredin H (2009) Undisplaced femoral neck fractures–no problems? A consecutive study of 224 patients treated with internal fixation. Injury 40(3):274–276. doi:10.1016/j.injury.(2008).05.023 (Epub 2008 Dec 13, PMID: 19070851)
Han SK, Song HS, Kim R, Kang SH (2016) Clinical results of treatment of garden type 1 and 2 femoral neck fractures in patients over 70-year old. Eur J Trauma Emerg Surg 42(2):191–196. doi:10.1007/s00068-015-0528-6 (Epub 2015 Apr 18, PMID: 26038046)
Kain MS, Marcantonio AJ, Iorio R (2014) Revision surgery occurs frequently after percutaneous fixation of stable femoral neck fractures in elderly patients. Clin Orthop Relat Res 472(12):4010–4014. doi:10.1007/s11999-014-3957-3 (Epub (2014) Sep 26, PMID: 25256623)
Parker MJ, White A, Boyle A (2008) Fixation versus hemiarthroplasty for undisplaced intracapsular hip fractures. Injury. 39(7):791–795. doi:10.1016/j.injury.2008.01.011 (Epub 2008 Apr 14, PMID: 18407277)
Raaymakers EL, Marti RK (1991) Non-operative treatment of impacted femoral neck fractures. A prospective study of 170 cases. J Bone Joint Surg Br 73(6):950–954 (PMID:1955443)
Sikand M, Wenn R, Moran CG (2004) Mortality following surgery for undisplaced intracapsular hip fractures. Injury. 35(10):1015–1019. doi:10.1016/j.injury.2004.01.004 (PMID:15351669)
Pfeiffer E (1975) A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc 23(10):433–441 (PMID: 1159263)
Garden RS (1974) Reduction and fixation of subcapital fractures of the femur. Orthop Clin North Am. 5(4):683–712 (PMID:4606995)
Probe R, Ward R (2006) Internal fixation of femoral neck fractures. J Am Acad Orthop Surg. 14(9):565–571 (PMID: 16959894)
Hardinge K (1982) The direct lateral approach to the hip. J Bone Joint Surg Br 64(1):17–19 (PMID:7068713)
Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am 51(4):737–755 (PMID:5783851)
Müssbichler H (1970) Arteriographic studies in fractures of the femoral neck and trochanteric region. Type and incidence of findings in pre- and postoperative examinations, relation to fracture dislocation and prognostic value. Angiology 21(6):385–402 (PMID:5452319)
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that we have no conflict of interest related directly or indirectly to this article.
Rights and permissions
About this article
Cite this article
Lu, Q., Tang, G., Zhao, X. et al. Hemiarthroplasty versus internal fixation in super-aged patients with undisplaced femoral neck fractures: a 5-year follow-up of randomized controlled trial. Arch Orthop Trauma Surg 137, 27–35 (2017). https://doi.org/10.1007/s00402-016-2591-9
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-016-2591-9