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Abstract
The conventional treatment for an undisplaced intracapsular hip fracture is internal
fixation. A possible alternative treatment is replacement hemiarthroplasty. We have
compared the outcomes of an age, sex and co-morbidity matched cohort of 346 patients
who have had their undisplaced intracapsular hip fracture treated using cannulated
screws with a group of 346 patients who have had a displaced intracapsular fracture
treated using a hemiarthroplasty. Patients treated by internal fixation had a shorter
operation time (43 versus 67 min), reduced orthopaedic ward stay (11 versus 15 days),
lower incidence of peri-operative complications (24 versus 81), and a lower 1-year
mortality (19% versus 26%). Additional benefits for the fixation group were less pain
at 1 year, less reduction in mobility and lower dependence on walking aids. All these
differences were statistically significant. Hemiarthroplasty had a lower re-admission
rate (43 versus 14 cases) and re-operation rate (59 versus 22 cases). These results
support the use of internal fixation for undisplaced intracapsular fractures and confirm
that the final outcome for an undisplaced intracapsular hip fracture is significantly
better than for a displaced intracapsular fracture, despite a higher re-operation
rate after internal fixation.