Cannulated screws versus hemiarthroplasty for displaced intracapsular femoral neck fractures in demented patients

Abstract

Backgrounds and aims: There are no randomised trials comparing internal fixation and hemiarthroplasty for a displaced intracapsular femoral neck fracture in relation to mental state.

Material and methods: To establish what should be the treatment of first choice, a prospective randomised clinical study was performed on 60 demented patients with displaced intracapsular femoral neck fractures, comparing internal fixation (n = 31) with hemiarthroplasty (n = 29).

Results: There was no significant difference in the mortality rate of both groups. Hemiarthroplasty was associated with significantly more loss of blood and more wound complications. Reoperation for secondary displacement of the fracture after internal fixation occurred in four patients. Although not-statistically significant, failure of internal fixation seemed to be higher after an inadequate osteosynthesis.

Conclusion: Postoperative mortality is high and the chance of successful rehabilitation very small for both types of treatment in this group of patients. In our opinion, demented patients should not be treated with a major surgical procedure like hemiarthroplasty. Internal fixation should be considered the treatment of choice, because it is a smaller operation than prosthetic replacement, with less morbidity. If adequate reduction can not be achieved, a primary hemiarthroplasty should be performed.