A difference in mortality could be investigated by assuming that there is no difference per se in mortality risk between patients with a displaced and undisplaced FNF. However, the current 2 RCTs were not large enough to address the mortality question. Therefore, an arthroplasty for the undisplaced FNF may also reduce the mortality compared with IF. Better mobilization after hip fracture is important as it is associated with reduced mortality after surgery (Kristensen et al. ( 2019) did find a faster mobility (Timed-Up-And-Go) in the hemiarthroplasty (HA) group and better mobilization is also found when comparing arthroplasty with IF in displaced FNF (Gjertsen et al. 2019) found a difference in patient-reported outcome after 1 year. There may be a lower reoperation rate but neither of the 2 RCTs (Lu et al. The meta-analysis included 2 randomized clinical trials (RCTs) that demonstrated a 5% reoperation frequency in the hemiarthroplasty group compared with 20–21% in the IF group (Lu et al. 2008, National Institute for Health and Care Excellence 2011, updated 2017) has been questioned by a recent meta-analysis demonstrating that treatment with hemiarthroplasty may reduce the relative risk of reoperation by 70% when compared with IF (Richards et al. The general consensus on treating an undisplaced femoral neck fracture (FNF) with internal fixation (IF) (Dansk Sygeplejeråd et al. Concerning reoperation, patients with a displaced FNF treated with arthroplasty had a lower risk of reoperation compared with IF for undisplaced FNF. It has to be considered that there were baseline differences in the groups but there was no difference in mortality risk up to 5 years post-surgery. Interpretation - Patients treated for a displaced FNF with arthroplasty had a higher risk of 30-day mortality compared with patients who had an undisplaced FNF treated with IF. Arthroplasty patients had adjusted HRs for reoperation of 0.8 (0.8–0.9) within 1 year, 0.8 (0.7–0.9) within 2 years, and 0.8 (0.8–0.9) within 5 years postoperatively compared with IF. There was an increased risk of mortality for arthroplasty within 30 days, HR 1.3 (95% CI 1.3–1.4), compared with IF but not after 1 and 5 years. Results - We included 19,260 FNF treated with arthroplasty and 10,337 FNF with IF. We calculated hazard ratios (HR) with 95% confidence intervals (CI) adjusting for relevant confounders. IF and arthroplasty patients were compared with regards to mortality and reoperation up to 5 years postoperatively. Data on medication, comorbidities, reoperation, and mortality were retrieved from other Danish medical databases. Patients and methods - Hip fracture patients were identified in the Danish Multidisciplinary Hip Fracture Registry during 2005–2015. We assume that, per se, there is no difference in mortality risk between patients with a displaced and an undisplaced FNF. In this population-based cohort study we compare the risk of mortality and reoperation in undisplaced FNF treated with IF and displaced FNF treated with arthroplasty in patients older than 70 years old. For severe fractures, surgery would be necessary.Background and purpose - Hemiarthroplasty has lower reoperation frequency and better mobilization compared with internal fixation (IF) in patients with undisplaced femoral neck fractures (FNF), which might translate into lower mortality. Your doctor may also recommend physical therapy to improve your mobilization and stretching abilities. Your doctor may also recommend imaging tests such as X-rays and MRI to confirm the diagnosis and find the specific location and cause of the fracture.įemoral neck stress fracture is treated by taking complete rest from your sports activities. The most common symptom of a femoral neck fracture is deep thigh or groin pain which increases during your activity, spreads to other parts, and increases during the night or while sitting on the chair with your legs down.įemoral neck stress fracture can be diagnosed with the help of a physical examination and tests such as the fulcrum test or one legged hop test. These fractures are usually caused in athletes and gymnasts because of their excessive training and changes in practice surfaces. An injury or crack caused in the femoral neck due to repetitive force, overuse of the bone or insufficiency in bone development, is termed a femoral neck stress fracture. The Femoral neck is a part of the thigh bone (femur) which connects the head of the femur to the shaft of the femur.
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