Internal fixation is associated with less initial operative trauma but has an increased risk of re-operation on the hip. Definite conclusions cannot be made for differences in pain and residual disability between the two groups. Future studies should concentrate on better reporting of final outcome measures and function. There is still a need for studies to define which patient groups are better served by the different treatment methods.
Thompson hemiarthroplasty is superior to Ullevaal screws in treating displaced femoral neck fractures in patients over 75 years. A prospective randomized study with two-year follow-up.
The Finnish orthopaedic tradition has preferred hemiarthroplasty to internal fixation in femoral neck fracture treatment, while in Sweden internal fixation has been the method of choice. We decided to study whether internal fixation would prove superior to hemiarthroplasty even in displaced femoral neck fractures in patients over 75 years old.
                We randomized 32 displaced femoral neck fractures in patients over 75 years old to receive internal fixation or hemiarthroplasty.
                Fifteen (47%) patients died within two years. Seven of 16 (44%) patients in the internal fixation group were reoperated, none in the hemiarthroplasty group (p = 0.007). Seven of the complications in the internal fixation group developed during the first year and it would have been unethical to continue the study.
                We conclude that displaced femoral neck fractures in patients over 75 years should be treated by arthroplasty.