title: Primary total hip arthroplasty versus internal fixation in displaced fracture of femoral neck in sexa- and septuagenarians.
abstract: BACKGROUND
  The optimal treatment of femoral neck fracture in the elderly patient is still under debate. In patients aged 60-80 years, the decision between internal fixation and arthroplasty remains controversial. The primary aim of the present study is to evaluate the functional outcome of patients aged 60-80 years with femoral neck fracture treated with total hip arthroplasty or closed reduction and internal fixation. The secondary aim is to evaluate the incidence of nonunion and avascular necrosis in femoral neck fracture in different age groups.
  
  
  METHODS
  We studied 100 patients affected by displaced fracture of the femoral neck from May 2007 through June 2010. There were 60 men and 40 women with mean age of 66 years. Fifty patients were treated with closed reduction and internal fixation with cannulated screws (group A), and the other 50 patients with total hip arthroplasty (group B). Mean surgical time, blood loss, duration of hospital stay, Harris hip score, complications, and need for reoperation were recorded.
  
  
  RESULTS
  Harris hip score was significantly higher in group B at 3-, 6-, 12-, and 18-month follow-up evaluation. The overall complication rate was 28 % in group A and 32 % in group B, which was not statistically significant. A statistically significant difference was found regarding patients who required reoperation in group A (20 %) compared with group B (no one). The average Harris hip score in the internal fixation group was 90.6 and in the total hip arthroplasty group was 93.7, which was statistically significant (p < 0.05). Our study showed an increased risk for intracapsular hip fracture developing nonunion with older age.
  
  
  CONCLUSIONS
  Primary total hip arthroplasty compared with internal fixation appears to be a reasonably safe method of treating displaced fracture of femoral neck in elderly patients. We also concluded that outcome regarding hip function is generally better after total hip arthroplasty compared with internal fixation.
  
  
  METHODS
  Level II-Prospective cohort study.
authors.affiliation: Government Hospital for Bone and Joint Surgery Barzulla Srinagar Kashmir, Srinagar, 190005, Jammu and Kashmir, India, drihwani@yahoo.co.in.
authors.forename: Iftikhar H
authors.initials: IH
authors.lastname: Wani
authors.forename: Sidhartha
authors.initials: S
authors.lastname: Sharma
authors.forename: Irfan
authors.initials: I
authors.lastname: Latoo
authors.forename: A Q
authors.initials: AQ
authors.lastname: Salaria
authors.forename: Munir
authors.initials: M
authors.lastname: Farooq
authors.forename: Masrat
authors.initials: M
authors.lastname: Jan
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D015331:Cohort Studies; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D005593:Fracture Fixation, Internal; D005599:Fractures, Ununited / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000453:epidemiology*; D020127:Recovery of Function; D016896:Treatment Outcome