A total of 56 male patients with a displaced
intracapsular fracture of the hip and a mean age of 81 years (62
to 94), were randomised to be treated with either a cemented hemiarthroplasty
(the Exeter Trauma Stem) or reduction and internal fixation using
the Targon Femoral Plate. All surviving patients were reviewed one
year after the injury, at which time restoration of function and
pain in the hip was assessed. There was no statistically significant
difference in mortality between the two groups (7/26; 26.9% for
hemiarthroplasty vs 10/30; 33.3% for internal fixation).
No patient treated with a hemiarthroplasty required further surgery,
but eight patients treated by internal fixation did (p = 0.005),
five requiring hemiarthroplasty and three requiring total hip arthroplasty.
Those treated by internal fixation had significantly more pain (p
= 0.02). The restoration of mobility and independence were similar
in the two groups. These results indicate that cemented hemiarthroplasty gives better
results than internal fixation in
We describe the outcome of tibial diaphyseal
fractures in the elderly (≥ 65 years of age). We prospectively followed 233
fractures in 225 elderly patients over a minimum ten-year period.
Demographic and descriptive data were acquired from a prospective
trauma database. Mortality status was obtained from the General
Register Office database for Scotland. Diaphyseal fractures of the
tibia in the elderly occurred predominantly in women (73%) and after
a fall (61%). During the study period the incidence of these fractures
decreased, nearly halving in number. The 120-day and one-year unadjusted
mortality rates were 17% and 27%, respectively, and were significantly
greater in patients with an open fracture (p <
0.001). The overall
standardised mortality ratio (SMR) was significantly increased (SMR
4.4, p <
0.001) relative to the population at risk, and was greatest
for elderly women (SMR 8.1, p <
0.001). These frailer patients
had more severe injuries, with an increased rate of open fractures
(30%), and suffered a greater rate of nonunion (10%). Tibial diaphyseal fractures in the elderly are most common in
women after a fall, are more likely to be open than in the rest
of the population, and are associated with a high incidence of nonunion
and mortality. Cite this article:
