[Femoral neck fractures in the elderly].

Issue 1: Arthroplasty vs ORIF • Non-displaced or minimally displaced fractures-standard treatment is closed reduction and internal fixation in all ages. o Hudson, CORR, 1998. At 8 year f/u  Nondisplaced treated with ORIF-no difference in revision rate compared to arthroplasty  Displaced treated with ORIF – higher 8 year cumulative revision rate in older patients compared to arthroplasty o However, patients with previous symptomatic hip arthritis or those with pathologic fractures may benefit from primary THA. • Displaced femoral neck fractures in the elderly – Arthroplasty is preferred. • Argument for ORIF rather than arthroplasty: o retaining a patient's femoral head will result in better hip function o quicker o cheaper o less blood loss o lower dislocation rate • Argument for THA rather than ORIF : o Faster mobilization, immediate WBAT o Less pain o Lower revision rate  the rate of reoperation following internal fixation of femoral neck fractures is relatively high.  A meta-analysis (Bhandari, JBJS, 2003)-rates of osteonecrosis and nonunion in hip fractures treated with fixation as high as 20% and 30%, respectively. • The relative risk of revision surgery after arthroplasty was LOWER compared with the risk after internal fixation (RR=0.23, p = 0.0003).