Abstract
There is no consensus as to whether osteosynthesis (OS) or hemiarthroplasty (HA) should be used as the primary treatment of displaced femoral-neck fracture. In a prospective matched-pair study, we compared 84 patients treated with OS with three screws and 84 patients treated with uncemented Austin-Moore HA focusing on functional parameters, reoperations and mortality. At 4 months after the fracture, functional recovery was not significantly different between the study groups. However, OS patients tended to have slightly better functional ability than HA patients, as more of them were able to walk out of doors (45.2% versus 39.2%), more were able to walk without walking aids (23.7% versus 16.7%), and more returned to live in their own homes (80%versus 72.9%). OS patients used slightly but not significantly less painkillers and had less hip pain than HA patients. OS patients had had 15.4% more reoperations by 4 months and 14.2% more by 1 year compared to the HA group. The 4-month and 1-year mortality rates of the study groups were of the same order. Functional recovery was slightly better after OS with three screws than after uncemented HA, although no significant differences were seen in a sample of this size. On the other hand, OS was associated with a higher reoperation rate.
Résumé
Il n’y a aucun consensus sur le traitement initial de la fracture déplacée du col fémoral entre ostéosynthèse (OS) ou hémiarthroplastie (HA). Dans une étude prospective appariée avec focalisation sur les paramètres fonctionnels, les réinterventions et la mortalité, nous avons comparé 84 malades traités par OS avec trois vis et 84 malades traités par HA de type Austin Moore non cimentée. Quatre mois après la fracture, la récupération fonctionnelle n’était pas significativement différente entre les deux groupes de l’étude. Cependant, les malades OS avaient tendance à avoir une meilleure fonction que les malades HA, avec une meilleure possibilité de marche à l’extérieur (45,2% contre 39,2%), de marche sans aide (23,7% contre 16,7%), et plus de retour à domicile (80% contre 7,9%). Les malades OS utilisaient, mais de façon non significative, moins d’antalgiques que les malades HA et avaient moins de douleurs de hanche. Les malades OS avaient 15,4% de plus de ré-opérations à 4 mois et 14,2% dans l’année, comparés au groupe HA. Le taux de mortalité à quatre mois et à un an était du même ordre dans les deux groupes. La récupération fonctionnelle est légèrement meilleure après OS avec trois vis qu’après HA non cimenté, bien qu’aucune différence significative n’ait été relevée dans cet échantillon. En revanche, OS est associé à un taux supérieur de réinterventions.
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Acknowledgements
We thank Eila Haapakoski for her persistence and honest work with the data collection and Hannu Vähänikkilä for help with the statistical analysis.
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