Systematic Review Of Internal Fixation Versus Hip Arthroplasty For Displaced Femoral Neck Fractures In The Elderly

Objective: To compare the effects of internal fixation with that of arthroplasty for displaced femoral neck fractures in the elderly. Methods: All RCTs of internal fixation versus hip arthroplasty for displaced femoral neck fractures in the elderly were identified. Two reviewers assessed the quality of the trials and extracted data independently. Results: Fifteen published trials including a total of 2301 patients were included. Nine studies compared internal fixation with hemiarthroplasty; Four studies compared internal fixation with total hip replacement; Two studies compared internal fixation with hemiarthroplasty or total hip replacement. It was clear that, compared with arthroplasty (hemiarthroplasty or total hip replacement), internal fixation is associated with a shorter length of surgery, and lower operative blood loss and need for transfusion. However, internal fixation is associated with an increased risk of re-operation when compared with arthroplasty because of fracture non-union and avascular necrosis. For the outcome of hospital stay and mortality, there was no difference betweentreatment methods. For the outcome of hip function, it was reported that arthroplasty was superior to internal fixation in most of studies included although a meta-analysis could not be performed. Conclusion: Both internal fixation and arthroplasty appear to produce comparable long term outcomes in surgically treating displaced femoral neck fractures in the elderly. Internal fixation is associated with less surgical trauma for the primary operation but fracture healing complications and secondary surgical operations are more prevalent. Because of poor reporting of outcomes, it is not possible to determine if any significant difference in other outcome measures (mortality and function) do exist. More trials with high quality on methodology are needed.