Comparison of screw fixation, femoral head replacement and total hip replacement in the treatment of displaced femoral neck fractures in the elderly

Objective To compare the efficacy of screw fixation, femoral head replacement and total hip arthroplasty (THA) in the treatment of displaced femoral neck fractures in the elderly. Methods The clinical data of 280 elderly patients with displaced femoral neck fractures from May 2013 to May 2018 in Peace Hospital Affiliated to Changzhi Medical College were retrospectively analyzed. According to the different surgical methods, 76 cases were treated with screw fixation in group A, among them, there were 32 males and 44 females, with the average age of (70.95±8.24) years old. And 92 cases with replacement of femoral head in group B, among them, 40 males and 52 females, with the average age of (72.84±9.14) years old. And 112 cases with THA in group C, among them, 59 were males and 53 were females, with the average age of (73.05±7.21) years old. The general data, intraoperative bleeding volume, operation time, complications and Harris score of hip function after surgery were compared among the three groups. Results Intraoperative blood loss, operation time and fracture healing time in group A were (95.05±20.14) mL, (47.06±10.14) min and (6.64±1.74) months, respectively. In group B, they were was (208.74±60.15) mL, (82.55±15.47) min and (5.01±1.25) months, respectively. In group C, they were (337.69±85.13) mL, (97.85±12.04) min and (4.36±1.04) months, respectively. In the comparison of intraoperative hemorrhage and operation time, group B and C were greater than group A, group C was greater than group B; in the comparison of fracture healing time, group B and group C were shorter than group A, and group C was shorter than group B; the difference was statistically significant (all P values 0.05). Twelve months after operation, Harris score was used to evaluate the hip joint function. The excellent and good rates of group A, B and C were 63.14% (48/76), 75.00% (69/92) and 83.93% (94/112), respectively. The excellent and good rates of group C were significantly higher than those of group A (P 0.05). Conclusions For elderly patients with displaced femoral neck fractures, appropriate and safe surgical procedures should be selected with comprehensive consideration of the patient's physical tolerance, personal intention and other factors. THA is suitable for patients with relatively good physical condition and high mobility requirements, and the effect of THA is better than that of femoral head replacement and compression screw fixation. Key words: Femoral neck fractures; Total hip arthroplasty; Femoral head replacement; Internal screw fixation; Aged