Internal fixation versus hemiarthroplasty for undisplaced femoral neck fractures in the aged

Objective To compare the clinical efficacy of internal fixation versus hemiarthroplasty in the treatment of undisplaced femoral neck fracture in the aged patients. Methods From September 2009 to May 2014, 63 consecutive patients of over 75 years old were treated surgically for undisplaced femoral neck fractures (Garden types Ⅰ and Ⅱ) at our department. Closed reduction and internal fixation with cannulated nails was adopted in 26 cases, including 11 males and 15 females (mean age, 83.9±4.9 years). Femoral head arthroplasty was adopted in 37 cases, including 10 males and 27 females (mean age, 81.6±3.4 years). The 2 groups were compared in terms of operation time, blood transfusion, major complications, reoperation rate, postoperative mortality, postoperative Visual Analog Scale (VAS) and Walking Ability Index (WAI) at different time points, and EQ-5D health states at the final follow-ups. Results The 63 patients were followed up for 12 to 68 months (average, 39.9 months). The operation time (30.7±16.2 min), hospitalization time (7.5±3.4 d), transfusion number (1), hospitalization expenses (18, 183±4, 820 Yuan) in the internal fixation group were significantly less than those in the hemiarthroplasty group (54.9±19.2 min, 13.7±3.0 d, 12, and 30, 843±7, 866 Yuan, respectively) (P 0.05). The postoperative VAS scores at 3 and 6 months and the final follow-up, and the WAI scores at 3 and 6 months in the hemiarthroplasty group were significantly lower than those in the internal fixation group while the EQ-5D scores in the hemiarthroplasty group were significantly higher than in the internal fixation group (P<0.05). Conclusions Internal fixation is simple, easy, and less invasive for the aged patients with undisplaced femoral neck fracture while hemiarthroplasty may result in less pain and better quality of life. The appropriate operation should be determined according to the systemic health status of a given patient and his or her demand for quality of life as well. Key words: Femoral neck fractures; Fracture fixation, internal; Arthroplasty, replacement, hip; Aged