Functional outcome after displaced femoral neck fractures treated with osteosynthesis or hemiarthroplasty: a matched-pair study of 714 patients.

Osteosynthesis (OS) and hemiarthroplasty (HA) are the commonest treatments for displaced cervical hip fractures in the elderly, but there is no consensus as to which is better. In this prospective matched-pair study we compared these methods as regards functional outcome. In 1989-1996, using the same standardized forms, all displaced cervical hip fractures were prospectively registered in the university hospitals of Oulu in Finland and Lund in Sweden. Osteosynthesis was performed in Lund and hemiarthroplasty in Oulu. Cross-matching, done for age, sex, preoperative residence, and ambulatory ability, resulted in 357 pairs of displaced fractures. More OS than HA patients could manage in their own homes or live semi-independently at 4 months after the fracture. OS patients had better ambulatory ability (p = 0.001) and used walking aids less than HA ones (p = 0.001). The reoperation rates at 4 months were the same among HA and OS patients, but at 1 year, OS patients had a higher reoperation rate (17%) than HA ones (9.5%).