Cannulated screws versus hemiarthroplasty for displaced intracapsular femoral neck fractures in demented patients

Backgrounds and Aims: There are no randomised trials comparing internal fix ation and hemiarthroplasty for a displaced intracapsular femoral neck fract ure in relation to mental state. Material and Methods: To establish what should be the treatment of first ch oice, a prospective randomised clinical study was performed on 60 demented patients with displaced intracapsular femoral neck fractures, comparing int ernal fixation (n = 31) with hemiarthroplasty (n = 29). Results: There was no significant difference in the mortality rate of both groups. Hemiarthroplasty was associated with significantly more loss of blo od and more wound complications. Reoperation for secondary displacement of the fracture after internal fixation occurred in four patients. Although no t statistically significant, failure of internal fixation seemed to be high er after an inadequate osteosynthesis. Conclusion: Postoperative mortality is high and the chance of successful re habilitation very small for both types of treatment in this group of patien ts. In our opinion, demented patients should not be treated with a major su rgical procedure like hemiarthroplasty. Internal fixation should be conside red the treatment of choice, because it is a smaller operation than prosthe tic replacement, with less morbidity. If adequate reduction can not be achi eved, a primary hemiarthroplasty should be performed.