title: Internal fixation versus cemented hemiarthroplasty for displaced femoral neck fractures in patients with severe cognitive dysfunction: a randomized controlled trial.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  A prospective randomized controlled trial.
  
  
  METHODS
  A tertiary care university hospital.
  
  
  METHODS
  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.
  
  
  METHODS
  IF using 2 cannulated screws or HA using a cemented Exeter unipolar arthroplasty.
  
  
  METHODS
  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.
  
  
  METHODS
  Therapeutic level II.
authors.affiliation: *Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden; and †Karolinska Institutet, Department of Clinical Science and Education, Orthopaedic Unit, Stockholm South Hospital/Södersjukhuset, Stockholm, Sweden.
authors.forename: Carl-Johan
authors.initials: CJ
authors.lastname: Hedbeck
authors.forename: Christian
authors.initials: C
authors.lastname: Inngul
authors.forename: Richard
authors.initials: R
authors.lastname: Blomfeldt
authors.forename: Sari
authors.initials: S
authors.lastname: Ponzer
authors.forename: Hans
authors.initials: H
authors.lastname: Törnkvist
authors.forename: Anders
authors.initials: A
authors.lastname: Enocson
mesh_terms: D001843:Bone Cements / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000150:complications*; D003131:Combined Modality Therapy / Q000295:instrumentation / Q000379:methods; D005260:Female; D005265:Femoral Neck Fractures / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D017759:Fractures, Malunited / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D062785:Hemiarthroplasty / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements