Thompson hemiarthroplasty is superior to Ullevaal screws in treating displaced femoral neck fractures in patients over 75 years. A prospective randomized study with two-year follow-up.
OBJECTIVE
The Finnish orthopaedic tradition has preferred hemiarthroplasty to internal fixation in femoral neck fracture treatment, while in Sweden internal fixation has been the method of choice. We decided to study whether internal fixation would prove superior to hemiarthroplasty even in displaced femoral neck fractures in patients over 75 years old.


METHODS
We randomized 32 displaced femoral neck fractures in patients over 75 years old to receive internal fixation or hemiarthroplasty.


RESULTS
Fifteen (47%) patients died within two years. Seven of 16 (44%) patients in the internal fixation group were reoperated, none in the hemiarthroplasty group (p = 0.007). Seven of the complications in the internal fixation group developed during the first year and it would have been unethical to continue the study.


CONCLUSIONS
We conclude that displaced femoral neck fractures in patients over 75 years should be treated by arthroplasty.
Puolakka
T J
TJ
Department of Surgery, Hatanpää Hospital, Tampere, Finland. timo.puolakka@tays.fi
Laine
H J
HJ
Tarvainen
T
T
Aho
H
H
D000368:Aged; D000369:Aged, 80 and over; D001178:Arthroplasty / Q000379:methods*; D005260:Female; D005265:Femoral Neck Fractures / Q000401:mortality / Q000601:surgery*; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012086:Reoperation; D016896:Treatment Outcome