Conservative versus surgical treatment for femoral fracture after total or hemiarthroplasty of hip.

This retrospective study compared internal fixation of a femoral fracture following total or hemiarthroplasty of hip with conservative treatment. Sixteen patients were included in the study and classified according to Johannsen. Seven of these patients were treated conservatively by skeletal traction (group A), while the remaining nine patients underwent internal fixation by Mennen plate in conjunction with bone graft (group B). All patients were followed for at least 2 years and evaluated clinically and radiographically using the Mayo Clinic score. The results of group B were superior to those of group A for fracture lines located proximally or extending distally to the tip of the prosthesis. Furthermore, two patients from group A in whom conservative treatment had failed underwent internal fixation, improving their final outcome. Regarding fracture distal to the tip of the prosthesis, there was no significant difference in final outcome between the groups. Our conclusion is that Mennen plate fixation should be considered the treatment of choice in femoral fracture around the tip of a prosthesis, and Mennen plate fixation for fracture distal to the tip should remain as a good option, especially for patients who would like to reduce the length of postoperative hospitalization.