Jns. Davison et al., Treatment for displaced intracapsular fracture of the proximal femur - A prospective, randomised trial in patients aged 65 to 79 years, J BONE-BR V, 83B(2), 2001, pp. 206-212
Citations number
13
Categorie Soggetti
Ortopedics, Rehabilitation & Sport Medicine","da verificare
We performed a prospective, randomised trial comparing three treatments for
displaced intracapsular fractures of the hip in 280 patients aged 65 to 79
years.
The mean patient survival was significantly higher in the group undergoing
reduction and internal fixation (79 months) compared with that with a cemen
ted Thompson hemiarthroplasty or a cemented Monk bipolar hemiarthroplasty (
61 months and 68 months, respectively). After three years, 32 of 93 patient
s (34.4%) who had undergone fixation had local complications, necessitating
further intervention in 28 (30%), There were no significant differences in
the functional outcome in survivors, who were reviewed annually to five ye
ars.
Either reduction and internal fixation or cemented hemiarthroplasty may be
offered as alternative treatments for a displaced intracapsular fracture in
a mobile and mentally competent patient under the age of 80 years. The cho
ice of procedure by the patient and the surgeon should be determined by the
realisation that the use of internal fixation is associated with a 30% ris
k of failure requiring further surgery. If this is accepted, however, hemia
rthroplasty is avoided, which, in our study has a significantly shorter mea
n survival time. The use of a bipolar prosthesis has no significant advanta
ge.