Internal Fixation Versus Cemented Hemiarthroplasty for Displaced Femoral Neck Fractures in Patients With Severe Cognitive Dysfunction

This is the authors' abstract. We don't add key points for this paper.

OBJECTIVES: To compare the outcome of internal fixation (IF) versus a cemented hemiarthroplasty (HA) in patients with a displaced femoral neck fracture and a severe cognitive dysfunction. DESIGN: A prospective randomized controlled trial. SETTING: A tertiary care university hospital. PATIENTS: Sixty patients with a displaced femoral neck fracture were randomized to IF (n = 30) or HA (n = 30). All patients suffered from severe cognitive dysfunction but were able to walk before the fracture. INTERVENTION: IF using 2 cannulated screws or HA using a cemented Exeter unipolar arthroplasty. MAIN OUTCOME MEASUREMENTS: Patients were reviewed at 4, 12, and 24 months after the fracture. Outcome assessments included complications, reoperations, hip function (Charnley score), and health-related quality of life (EQ-5Dindex score). RESULTS: A total of 8 patients were reoperated (14%); 7 in the IF group and 1 in the HA group. The EQ-5Dindex score at the follow-ups were generally lower in the IF group compared with the HA group with a significant difference at 12 months (P = 0.03). No difference was seen in hip function, general complications, or mortality between the groups. CONCLUSIONS: HA seems to provide a safe option with better health-related quality of life and less risk for reoperations compared with IF for these patients. LEVEL OF EVIDENCE: Therapeutic level II.