OSTEOSYNTHESIS VERSUS ENDOPROSTHESIS IN THE TREATMENT OF UNSTABLE INTRACAPSULAR HIP-FRACTURES IN THE ELDERLY - A RANDOMIZED CLINICAL-TRIAL

Forty-three elderly patients with an intracapsular hip fracture were s elected for a prospective randomised trial comparing osteosynthesis (D HS) versus primary hemiarthroplasty (HA) with a 3-year follow-up. The duration of the operation and the perioperative blood loss were signif icantly shorter in DHS, but inadequate reduction and/or fixation led t o serious problems in this group. Clinical morbidity was lower after D HS. No difference could be demonstrated in the mortality rates, fractu re- or operation-related complications or the need for secondary inter vention. Reintervention could be carried out without additional risk i n both groups and did not lead to poor end results. Comparable results were obtained with both methods up to 24 months. At the 36-month foll ow-up, a significantly worse outcome could be demonstrated in the HA g roup. We conclude that osteosynthesis is justified as the primary trea tment of displaced intracapsular hip fractures in elderly patients. En doprosthetic replacement can be safely used in cases where osteosynthe sis has failed.