Aims: To evaluate a new treatment protocol for femoral neck fractures based on our own and other authorsñ randomised studies concerning choice of surgical treatment. Methods: Consecutive study of 358 patients, 1-year follow-up. According to our new program all undisplaced fractures and all fractures in patients under 70 years were treated with close reduction and Hansson hook pins. Active, independent patients aged 70 Ð 80 years with displaced fractures received a total arthroplasty, the frailer patients in this age group and all those over 80 years received a hemi-arthroplasty. Internal þxation could be chosen for patients with life threatening diseases. Results: Introducing primary arthroplasty in our new program instead of internal þxation for a majority of the displaced fractures reduced the failure rate for patients over 70 years from 42% to 5%. Internal þxation for displaced fractures in patients under 70 years had a 48% failure rate, but risk factors for failure were frequent among these patients. Undisplaced fractures had a failure rate of 14%. The study compromises the þrst year with this new protocol and in 4% of the cases the surgeon did not adhere to the protocol. Mortality for women was 5% at 1 month and 21% at 1 year; for men 12 and 32% respectively. Conclusions: We consider the treatment regime successful and feasible and 1 year follow up shows adherence to the new program. Primary arthroplasty for displaced fractures for a great majority of all patients over 70 years has signiþcantly reduced the failure rate compared to earlier results after internal þxation.

It remains a matter of debate whether displaced fractures of the neck of the femur should be treated by internal fixation or arthroplasty. We have compared the two methods with regard to complications, mortality and functional outcome.

We studied 409 patients, aged 70 years and over, with subcapital fractures graded as Garden 3 or 4, in a two-year prospective multicentre study from 12 Swedish hospitals. They were randomised to internal fixation or arthroplasty. Patients who were mentally confused, bedridden or in a nursing-home were excluded from the survey.

After two years the rate of failure was 43% in the internal fixation (IF) and 6% in the arthroplasty group (p < 0.001). In the IF group 36% had impaired walking and 6% had severe pain compared with 25% and 1.5%, respectively, in the arthroplasty group (both p < 0.05). There was no difference in mortality.

With a high rate of failure and poor functional outcome after IF, we recommend primary arthroplasty for displaced fractures of the neck of the femur in patients over 70 years of age.