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The management of intracapsular hip fractures in the 'young elderly' internal fixation or total hip replacement?
Rupert Talboys1, Luke Pickup, Adrian Chojnowski
1Orthopaedics and Trauma Department, Norfolk & Norwich University Hospital, NHS Trust, Norwich, UK. r.talboys@uea.ac.uk
Insights
For displaced intracapsular hip fractures in younger elderly patients, Total Hip Replacement (THR) shows better outcomes than Internal Fixation (IF). IF is suitable for undisplaced fractures, but further research is needed.
Area of Science:
- Orthopedic Surgery
- Geriatric Medicine
- Traumatology
Background:
- Intracapsular hip fractures in the 'young elderly' (50-75 years) lack treatment consensus.
- Current evidence suggests Internal Fixation (IF) for undisplaced and Total Hip Replacement (THR) for displaced fractures in older, mobile patients.
Purpose of the Study:
- To compare the efficacy and outcomes of Internal Fixation (IF) versus Total Hip Replacement (THR) for intracapsular hip fractures in patients aged 50-75.
- To evaluate complication rates, mortality, functional outcomes (Oxford Hip Score), and pain levels (Numeric Pain Score) associated with each treatment method.
Main Methods:
- Retrospective cross-sectional study of 263 patients with intracapsular hip fractures (2000-2009).
- Review of patient radiographs and complication/mortality data.
- Patient-reported outcomes via Oxford Hip Score (OHS) and Numeric Pain Score (NPS) questionnaires.
Main Results:
- For displaced fractures, THR demonstrated significantly better functional outcomes (OHS: 16.0 vs. 20.0, p=0.029) and reduced pain (NPS: 2.0 vs. 4.0, p=0.007) compared to IF.
- THR was associated with lower complication rates (OR 2.90, p=0.006) and mortality (OR 3.61, p=0.007) in displaced fractures.
- No significant difference in functional outcome or complications was observed between IF and THR for undisplaced fractures.
Conclusions:
- Total Hip Replacement (THR) is associated with superior functional outcomes, reduced pain, and lower complication/mortality rates for displaced intracapsular hip fractures in the 'young elderly'.
- Internal Fixation (IF) appears appropriate for undisplaced intracapsular hip fractures, showing comparable functional outcomes and complication rates.
- A large randomized controlled trial is recommended to validate these findings and establish definitive treatment guidelines.
Abstract:
There is a lack of consensus about how to treat intracapsular hip fractures in the 'young elderly' (50-75 years). Evidence for older more mobile patients seems to point towards Internal Fixation (IF) for undisplaced fractures and Total Hip Replacement (THR) for displaced fractures. Radiographs of 263 patients from the Norfolk and Norwich University Hospital, who have suffered an intracapsular hip fracture between 2000-2009 were reviewed. The complication and mortality rates were noted. A Hip function questionnaire (Oxford hip score (OHS)) and Numeric pain score (NPS) were sent out to patients, then methods of treatment (IF and THR) were compared. In displaced fractures THR compared favourably to IF, OHS (16.0 vs. 20.0 p 0.029), NPS (2.0 vs. 4.0 p 0.007), complications (Odds Ratio (OR) 2.90; p 0.006) and death rate (OR 3.61; p 0.007). Although not statistically significant when stratified for age, the youngest age group (50-60) still achieved better function with a THR (13.0 vs. 18.0 ; p 0.129). There was little difference in the results for undisplaced fractures. This retrospective cross-sectional study showed IF is associated with a much higher complication rate than THR for patients who sustained a displaced hip fracture. THR also showed a better functional outcome and reduced pain. IF should be used in undisplaced fractures as there was no difference in functional outcome or complication rate. A large randomised controlled trial is needed to confirm these results.
