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.
Osteosynthesis versus endoprosthesis in the treatment of unstable intracapsular hip fractures in the elderly. A randomised clinical trial.
Forty-three elderly patients with an intracapsular hip fracture were selected for a prospective randomised trial comparing osteosynthesis (DHS) versus primary hemiarthroplasty (HA) with a 3-year follow-up. The duration of the operation and the perioperative blood loss were significantly shorter in DHS, but inadequate reduction and/or fixation led to serious problems in this group. Clinical morbidity was lower after DHS. No difference could be demonstrated in the mortality rates, fracture- or operation-related complications or the need for secondary intervention. Reintervention could be carried out without additional risk in 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 follow-up, a significantly worse outcome could be demonstrated in the HA group. We conclude that osteosynthesis is justified as the primary treatment of displaced intracapsular hip fractures in elderly patients. Endoprosthetic replacement can be safely used in cases where osteosynthesis has failed.