Internal fixation or hemiarthroplasty for undisplaced intracapsular hip fractures: a randomized trial

Introduction: Currently the recommended treatment for an undisplaced intracapsular hip fracture is internal fixation. Recent studies have questioned this practice and suggested arthroplasty may be a more appropriate treatment method. Methods: 54 patients with an undisplaced intracapsular fracture were randomised between a cemented polished tapered stem hemiarthroplasty and internal fixation with Targon hip screws. The principle outcome was regain of mobility. Secondary outcomes included degree of residual pain, mortality, secondary surgery and surgical complications. Follow-up was by a nurse blinded to the implant and continued till three years from surgery for the surviving patients. Results: No significant differences in the primary outcome of regain of mobility were noted. Arthroplasty was associated with lower degrees of residual pain. No surgical complications were encountered in the arthroplasty group. In the fixation group there was one case of later fracture around the implant requiring surgery and two cases of avascular necrosis of the femoral head. There were no notable differences in mortality, hospital stay or general medical complications between the two groups. Conclusions: Arthroplasty may lead to improved outcomes compared to internal fixation in the treatment of an undisplaced intracapsular fracture in the elderly but further studies are required to confirm this.