Abstract
Forty-three elderly patients with an intracapsular hip fracture were selected for a prospective randomised trial comparing osteosynthesis (DHS) versus primary hemiarthroplasty (HA) with a 3-year follow-up. The duration of the operation and the perioperative blood loss were significantly shorter in DHS, but inadequate reduction and/or fixation led to serious problems in this group. Clinical morbidity was lower after DHS. No difference could be demonstrated in the mortality rates, fracture- or operation-related complications or the need for secondary intervention. Reintervention could be carried out without additional risk in both groups and did not lead to poor end results. Comparable results were obtained with both methods up to 24 months. At the 36-month follow-up, a significantly worse outcome could be demonstrated in the HA group. We conclude that osteosynthesis is justified as the primary treatment of displaced intracapsular hip fractures in elderly patients. Endoprosthetic replacement can be safely used in cases where osteosynthesis has failed.
Similar content being viewed by others
References
Barnes R, Brown JT, Garden RS, Nicoll EA, Goda DF (1976) Subcapital fractures of the femur. A prospective study. J Bone Joint Surg [Br] 58:2–24
Böhler J (1978) Differenzierte Indikationsstellung bei Schenkelhalsbrüchen. Unfaltheilkunde 81:155–163
Bray TJ, Smith-Hoefer E, Hooper A, Timmerman L (1988) The displaced femoral neck fracture. Internal fixation versus bipolar endoprosthesis. Results of a prospective randomized comparison. Clin Orthop 230:127–140
Broos PLO (1985) Hip fractures in the elderly. Literature. A prospective study of 384 consecutive cases. Thesis, Nijmegen
Broos PLO, Stappaerts KH, Luiten EJT, Gruewez JA (1987) Endoprosthesis. The best way to treat unstable intracapsular hip fractures in elderly patients. Unfallchirurg 90:347–350
Brown JT, Abrami G (1964) Transcervical femoral fracture. A review of 195 patients treated by sliding-nail plate fixation. J Bone Joint Surg [Br] 46:648–663
Garden RS (1977) Selective surgery in medial fractures of the femoral neck: a review. Injury 9:5–7
Hunter GA (1969) A comparison of the use of internal fixation and prosthetic replacement for fresh fractures of the neck of the femur. Br J Surg 56:229–233
Hunter GA (1974) A further comparison of the use of internal fixation and prosthetic replacement for fresh fractures of the neck of the femur. Br J Surg 61:382–384
Johnson JTH, Crothers O (1975) Nailing versus prosthesis for femoral-neck fractures. A critical review of long-term results in 239 consecutive private patients. J Bone Joint Surg [Am] 57:686–692
Leadbetter GW (1935) A treatment for fracture of the neck of the femur. J Bone Joint Surg 15:931–940
Nicoll EA (1986) The unsolved fracture. J Bone Joint Surg [Br] 45:239–241
Raine GET (1973) A comparison of internal fixation and prosthetic replacement for recent displaced subcapital fractures of the neck of the femur. Injury 5:23–30
Regazzoni P, Rüedi T, Winquist R, Allgöwer M (1984) The dynamic hip screw implant system. Springer, Berlin Heidelberg New York
Riley TBH (1978) Knobs or screw? A prospective trial of prosthetic replacement against internal fixation of subcapital fractures. J Bone Joint Surg [Br] 60:136
Sikorski JM, Barrington R (1981) Internal fixation versus hemiarthroplasty for the displaced subcapital fracture of the femur. A prospective randomised study. J Bone Joint Surg [Br] 63:357–361
Söreide O, Möister A, Raugstad TS (1979) Internal fixation versus primary prosthetic replacement in acute femoral neck fractures: a prospective randomized clinical study. Br J Surg 66:56–60
Stewart HD (1983) Pugh's nail fixation versus Thompson's prosthesis for displaced subcapital fractures of the femur. Injury 15:227–231
Lingen B van (1981) (in Dutch). Ned Tijdschr Geneesk 125:1083–1084
Vugt AB van (1991) The unsolved fracture. A prospective study of 224 consecutive cases with an intracapsular hip fracture. Thesis, University of Nijmegen
Verberne GHM (1985) (in Dutch). Thesis, University of Amsterdam (1986)
Villar RN, Grover ML, Thomas WG (1986) Prevention of rotation of the femoral head during internal fixation of subcapital fractures. Injury 17:61
Watson-Jones R (1936) Fractures of the neck of the femur. Br J Surg 23:787–808
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
van Vugt, A.B., Oosterwijk, W.M. & Goris, R.J.A. Osteosynthesis versus endoprosthesis in the treatment of unstable intracapsular hip fractures in the elderly. Arch Orthop Trauma Surg 113, 39–45 (1993). https://doi.org/10.1007/BF00440593
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF00440593