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Evidence summaries

Outcomes after Displaced Fractures of the Femoral Neck

Arthroplasty may be associated with fewer secondary major operations than internal fixation in the treatment of displaced fractures of the femoral neck. Level of evidence: "C"

A systematic review 1 including 106 studies with a total of 6 333 subjects undergoing internal fixation, 13 090 undergoing hemiarthroplasty, and 746 undergoing total hip replacement, was abstracted in DARE. The rate of reoperation within two years ranged from 20 - 36% after internal fixation and from 6 - 18% after hemiarthroplasty (relative risk 2.6, 95% CI 1.4 to 4.6). Most common reasons for reoperation were non-union (33%) and avascular necrosis (16%). Patients reported less pain after arthroplasty than after internal fixation (15% vs 30%, p=0.05). There was no significant difference in mobility between treatment groups. There was no significant difference between internal fixation and arthroplasty with regard to the incidence of deep vein thrombosis and pulmonary embolism. There were more deep infections after arthroplasty than after internal fixation (p=0.001).

Comment: There are limitations in the quality of the data.

    References

    • Lu-Yao GL, Keller RB, Littenberg B, Wennberg JE. Outcomes after displaced fractures of the femoral neck. A meta-analysis of one hundred and six published reports. J Bone Joint Surg Am 1994 Jan;76(1):15-25. [PubMed] [DARE]

Primary/Secondary Keywords