Introduction: During the last decade the treatment regime for dislocated femoral neck fractures has switched towards more arthroplasties. There has been apprehensions regarding long-term results for arthroplasties. The opinion has been put forward that preserving the femoral head is preferable to performing total hip arthroplasty.

Methods: 409 of the 450 patients in a randomized study 1995–97 had valid follow-up at 4 months, 1, 2, 5, and 10 years (or until deceased). Mentally intact, independently living and walking patients over 70 years were included and randomized to osteosynthesis (n=217) or arthroplasty (n=192).

Results: After 10 years 168 patients (77 percent) were deceased and there were 99 failures (46 percent) in the osteosynthesis group. In the arthroplasty group 145 patients (76 percent) were deceased and there were 17 failures (9 percent) after 10 years. Both groups had the same rate of failure between 2 and 10 years.

There was significantly better results regarding pain and function in the arthroplasty group at 4 months. At 10 years the results were still not superior for osteosynthesis.

A Cox regression analysis regarding sex, age, time to surgery, smoking, osteoporosis, trauma type, preoperative function and choice of skin incision comparing the patients without hip complications at 10 years with the patients with failures in each group revealed no risk factor for failure.

Discussion: Arthroplasty for hip fracture show a reliable long-term result while osteosynthesis leads to a high rate of complications and is not superior regarding pain and function even when successful. Both methods have the same mortality.

Background: The Hansson Twin Hook (HTH) is an alternative to the sliding hip screw in the treatment of trochanteric fractures. In osteoporotic bone, biomechanical tests indicate better fixation properties of the HTH than of the lag screw. Our aim was to evaluate the technical results of the HTH in a larger series of osteoporotic patients with intertrochanteric fractures. Many surgeons were involved to assess, if the device was user-friendly.

Patients and Methods: In a prospective bicentric study, 55 surgeons used the HTH and a standard plate in 157 consecutive patients with intertrochanteric fractures, of which 83% were unstable. The mean age of the patients was 83 years. The patients were followed regularly clinically and radiographically for at least 4 months with a final control at 2 years.

Results: Technical intraoperative errors were done in 7 of the patients. The reduction of the fracture was inaccurate in these cases; hence the HTH had not been placed centrally in the femoral head. Two of the 7 intraoperative errors developed into failures of fixation (1.3%) during the 2-year period.

Interpretation: The HTH achieves adequate fixation purchase in osteoporotic bone, has a low failure rate and is easy to use.

In a series of 450 patients over 70 years of age with displaced fractures of the femoral neck sustained between 1995 and 1997 treatment was randomised either to internal fixation or replacement. Depending on age and level of activity the latter was either a total hip replacement or a hemiarthroplasty. Patients who were confused or bed-ridden were excluded, as were those with rheumatoid arthritis. At ten years there were 99 failures (45.6%) after internal fixation compared with 17 (8.8%) after replacement. The rate of mortality was high at 75% at ten years, and was the same in both groups at all times. Patient-reported pain and function were similar in both groups at five and ten years. Those with successfully healed fractures had more hip pain and reduction of mobility at four months compared with patients with an uncomplicated replacement, and they never attained a better outcome than the latter patients regarding pain or function.

Primary replacement gave reliable long-term results in patients with a displaced fracture of the femoral neck.

Aims: To evaluate a new treatment protocol for femoral neck fractures based on our own and other authorsñ randomised studies concerning choice of surgical treatment. Methods: Consecutive study of 358 patients, 1-year follow-up. According to our new program all undisplaced fractures and all fractures in patients under 70 years were treated with close reduction and Hansson hook pins. Active, independent patients aged 70 Ð 80 years with displaced fractures received a total arthroplasty, the frailer patients in this age group and all those over 80 years received a hemi-arthroplasty. Internal þxation could be chosen for patients with life threatening diseases. Results: Introducing primary arthroplasty in our new program instead of internal þxation for a majority of the displaced fractures reduced the failure rate for patients over 70 years from 42% to 5%. Internal þxation for displaced fractures in patients under 70 years had a 48% failure rate, but risk factors for failure were frequent among these patients. Undisplaced fractures had a failure rate of 14%. The study compromises the þrst year with this new protocol and in 4% of the cases the surgeon did not adhere to the protocol. Mortality for women was 5% at 1 month and 21% at 1 year; for men 12 and 32% respectively. Conclusions: We consider the treatment regime successful and feasible and 1 year follow up shows adherence to the new program. Primary arthroplasty for displaced fractures for a great majority of all patients over 70 years has signiþcantly reduced the failure rate compared to earlier results after internal þxation.

It remains a matter of debate whether displaced fractures of the neck of the femur should be treated by internal fixation or arthroplasty. We have compared the two methods with regard to complications, mortality and functional outcome.

We studied 409 patients, aged 70 years and over, with subcapital fractures graded as Garden 3 or 4, in a two-year prospective multicentre study from 12 Swedish hospitals. They were randomised to internal fixation or arthroplasty. Patients who were mentally confused, bedridden or in a nursing-home were excluded from the survey.

After two years the rate of failure was 43% in the internal fixation (IF) and 6% in the arthroplasty group (p < 0.001). In the IF group 36% had impaired walking and 6% had severe pain compared with 25% and 1.5%, respectively, in the arthroplasty group (both p < 0.05). There was no difference in mortality.

With a high rate of failure and poor functional outcome after IF, we recommend primary arthroplasty for displaced fractures of the neck of the femur in patients over 70 years of age.