Abstract
Introduction
Displaced femoral neck fractures in elderly are normally treated with 2 screws/pins (IF) or bipolar hemiarthroplasty (HA). The aim of this study was to compare IF and HA as treatment for displaced femoral neck fractures using reoperations and functional result (patient satisfaction, pain, and quality of life) as outcome.
Material and Methods
From January 2005 all hip fractures in Norway are reported to the Norwegian Hip Fracture Register. At 4, 12, and 36 months postoperatively a questionnaire assessing satisfaction (VAS 0-100), pain (VAS 0-100), and quality of life (EQ-5D) is sent to the patients. To ensure more than 3 years follow-up, only patients operated in 2005 were included in the present study. Consequently 1,968 patients over 70 years of age operated with IF (n = 958) or HA (n = 1,010) due to displaced femoral neck fractures were included in the analyses on reoperations. Of these, 280 patients responded to all questionnaires and were included in the analyses on functional results (IF: n = 135, HA: n = 145). The patients remained in the same treatment group according to the intention-to-treat principle.
Results
Through December 2008 496 (51.8%) patients had died in the IF group and 519 patients (51.4%) in the HA group. There were 238 (24.8%) reoperations performed in the IF group and 26 (2.6%) in the HA group. For the 280 patients included in the analyses on functional results, no preoperative differences were found between the two treatment groups concerning sex, comorbidity (ASA-class), cognitive dysfunction, and EQ-5Dindexscore. However, the patients in the HA group were older than the patients in the IF group (79.7 vs 77.7 years, p = 0.002). At all follow-ups, the HA-group were significant more satisfied with the result of the operation compared to the IF-group. The HA group reported less pain compared to the IF group after four months (18 vs 35, p<0.001) and after twelve months (16 vs 29, p<0.001). After 3 years no difference in pain between the two groups could be found. After four months the EQ 5Dindexscore was 0.69 in the HA-group and 0.58 in the IF-group (p<0.001), after twelve months 0.75 in the HA-group and 0.67 in the IF-group (p = 0.001), and after 3 years follow-up 0.74 in the HA-group and 0.71 in the IF-group (p<0.089).
Discussion and Conclusion
There were more reoperations in the IF group than in the HA group. The superior functional results found in the HA group after 4 and 12 months were less evident after 3 years. For this frail patient group, a short rehabilitation period with minimized need for reoperations is important, and consequently, a hemiarthroplasty should be recommended as treatment for displaced femoral neck fractures.
