Internal fixation versus hip arthroplasty in patients with nondisplaced femoral neck fractures: short-term results from a geriatric trauma registry

Abstract

Purpose To determine whether internal fixation (IF) or hip arthroplasty (HA) is associated with superior outcomes in geriatric nondisplaced femoral neck fracture (FNF) patients. Methods Data from the Registry for Geriatric Trauma of the German Trauma Society (ATR-DGU) were analyzed (IF Group 449 and HA Group 1278 patients). In-hospital care and a 120-day postoperative follow-up were conducted. Primary outcomes, including mobility, residential status, reoperation rate, and a generic health status measure (EQ-5D score), and the secondary outcome of mortality were compared between groups. Multivariable analyses were performed to assess independent treatment group associations (odds ratios, ORs) with the primary and secondary end points. Results Patients in the HA group were older (83 vs. 81 years, p < 0.001) and scored higher on the Identification of Seniors at Risk screening (3 vs. 2, p < 0.001). We observed no differences in residential status, reoperation rate, EQ-5D score, or mortality between groups. After adjusting for key covariates, including prefracture ambulatory capacity, the mobility of patients in the HA group was more frequently impaired at the 120-day follow-up (OR 2.28, 95% confidence interval = 1.11–4.74). Conclusion Treatment with HA compared to treatment with IF led to a more than twofold increase in the adjusted odds of impaired ambulation at the short-term follow-up, while no significant associations with residential status, reoperation rate, EQ-5D index score, or mortality were observed. Thus, IF for geriatric nondisplaced FNFs was associated with superior mobility 120 days after surgery. However, before definitive treatment recommendations can be made, prospective, randomized, long-term studies must be performed to confirm our findings.

Internal fixation or hip replacement for undisplaced femoral neck fractures? Pre-fracture health differences reflect survival and functional outcome

“…IF is a hip-preserving method, thus one could theorize that the fracture may not have fully healed 4 months after surgery. However, both our study and a recent study by Laubach et al show that, compared with HA (but not THA), IF patients recover as well or better in terms of mobility even within 4 months ( 12 ). 2 recent review studies reported no clinical benefits of THA compared with HA when adjusting for confounders ( 13 , 14 ).…”

Management of Garden-I and II Femoral Neck Fractures: Perspectives on Primary Arthroplasty

“…46 Several other studies also showed lack of statistical significance when comparing internal fixation and arthroplasty in the domain of mortality (Table 2). [47][48][49][50] Most of the comparative studies to date, however, do not report a reliable method of measuring functional outcomes, if at all. Functional capabilities of patients postoperatively can have profound impacts on their quality of life and, subsequently, morbidity and mortality.…”