We compared the reoperation rate after internal fixation for minimally displaced or impacted intracapsular fractures of the femoral neck in patients aged 80 years and above with that in similar patients aged 65 to 79 years. We also compared the results of internal fixation with those of hemiarthroplasty for displaced intracapsular fracture in an age- and sex-matched group of elderly patients. We found that a significantly greater proportion of the older patients treated by internal fixation required reoperation than either the younger group or the age-matched group treated by hemiarthroplasty. Our results indicate that internal fixation may not be the best treatment for extremely elderly patients with minimally displaced or impacted intracapsular fractures of the femoral neck.

One hundred consecutive closed fractures of the adult tibial shaft treated by closed methods were surveyed prospectively in order to observe their natural history. The fractures were analysed with regards to speed of healing and the influence of age, sex, causal force, radiological morphology and concurrent fibular fracture. At 20 weeks 19 fractures had not yet united, but 15 of these had united by 30 weeks with conservative treatment alone. The remaining four cases were operated upon because no further progress in healing was anticipated. These findings suggest that, with regard to healing, open reduction and internal fixation is rarely justified in closed adult tibial shaft fractures.