Internal fixation or arthroplasty for displaced subcapital fractures in the elderly?

A series of 200 patients aged over 69 years admitted to this hospital with a non-pathological displaced subcapital fracture of the femur, have been studied prospectively. Approximately one-half were treated by internal fixation and the remainder by a hemiarthroplasty, the method of treatment being dictated by the preference of the on-call consultant. This has enabled a comparison between the two groups. At 1 year from injury there was no significant difference in the mortality or function of the survivors. Internal fixation resulted in fewer postoperative complications, a shorter hospital stay and a reduced cost of treatment. The reoperation rate for internal fixation was three times that after hemiarthroplasty. Despite the problem of non-union, this study suggests that internal fixation is the treatment of choice for displaced subcapital fractures in the elderly.