A prospective, randomised study was conducted to evaluate the clinical and functional outcomes at 12 months of followup in two groups of patients affected by femoral neck fractures and treated with cemented or cementless bipolar hemiarthroplasty. Fiftythree cemented and 53 cementless prostheses were implanted on alternate days in 106 consecutive patients. We considered general demographic variables (age, sex, side of injury), operative delay, number of pre-existing conditions, ASA score, haemoglobin levels at admission and pre-and postoperatively, number of blood units transfused perioperatively, duration of operation, clinical complications, hospital stay and mortality within one year after discharge. At followup, a Total Functional Score (from 0 to 18 points) was used to evaluate walking ability and personal and daily activity. Furthermore, the economic costs of hospital care (medical and nursing staff, drugs, diagnostic procedures, blood transfusions, hospital stay) and prostheses in the 2 groups of patients were considered. There was no significant difference between the 2 groups of patients regarding most variables, except for postoperative haemoglobin value (9.60±1.88 g/dl in cemented group vs 8.80±8.70 g/dl in cementless group, p=0.018) and duration of operation (75.00±22.43 min in cemented group and 56.98±55.00 min in cementless group, p<0.001). Furthermore, there was no difference regarding 1-year mortality (24.5% in cemented group and 26.4% in cementless group) or in total functional score (9.13±6.02 in cemented group and 8.95±5.86 in cementless group). Economic evaluation revealed that the cementless implant costs 1980 euro while the cemented one costs 1065 euro. In our study, the morbility rate for elderly patients with femoral neck fracture was higher than in the literature. The mortality rate and functional outcome at 12 months of follow-up were similar in the two groups of patients. Considering the higher cost for the cementless prosthesis, the use of cementless bipolar hemiarthropalsy does not seem to be justified in daily orthopaedic practice for the treatment of femoral neck fractures in elderly patients.

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Treatment of peritrochanteric fractures involves reduction and synthesis using reconstruction plates and screws, intramedullary or cephalomedullary nails, or external fixators. A new cephalomedullary nail, Endovis BA (Citieffe, Italy), made of titanium alloy implanted without reaming and is fixed with 2 cephalic screws was used to treat 1091 patients with lateral fractures of the femoral neck (AO class 31-A). The patients had a mean age of 75 years (range, 48-99 years), and 83% had one or more systemic comorbidities. Mean operative time was 35 min (range, 20-100 min), and 483 patients (44.3%) required transfusion of one or more units of blood. The nail was implanted without distal blockage in 886 patients (81.2%) and without reaming in 1081 patients (99.1%). Intra-operative complications were recorded in 28 patients (2.6%). At the 6-month follow-up, 128 patients (12%) had died from causes unrelated to the surgery. Of the remaining 963 patients, 632 (65.6%) could walk independently, 249 (25.9%) could walk with assistance, and 82 (8.5%) could not walk. Postoperative complications were recorded in 38 patients (3.5%); most common complications were cut-out (10 cases), loss of reduction (8 cases) and prominent screws (6 cases). In conclusion the Endovis BA nail seems to be a reliable choice for the treatment of lateral fractures of the femoral neck, especially considering the short operating time and low rate of complications.

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Figure 4. Cross-sectional views of the heart after 90-minute standard (A) and autoperfusion (B) inflations. A large area of necrosis (white area) is outlined in panel A by arrows; the small area of damage in panel B is likely the result of a small side branch occlusion of the circumflex coronary artery. (From Campbell et al.