Nail versus screw fixation of femoral neck fractures. A 2-year radiological and clinical prospective study.

137 recent femoral neck fractures were randomly allocated in a prospective study to internal fixation with either Nyström nails or Scand screws. A radiological and clinical follow-up was conducted of all survivors one and two years postoperatively. Reduction was unsatisfactory in 15 of 87 patients included in the two-year follow-up study. 13 of them developed complications. The 44 Nyström-nailed fractures included in the two-year follow-up showed sliding of the nail in 22 cases, redisplacement/nonunion in 14, and late segmental collapse in 5. The results of clinical examination were excellent or good in 30 patients and fair or poor in 14. Among the 43 Scand-screwed fractures sliding of the screw occurred in 1 case, redisplacement/nonunion in 14, and late segmental collapse in 4. In 35 patients the result was graded as excellent or good and in 8 as fair or poor. No statistical difference between the groups was found with respect to the incidence of redisplacement, nonunion and late segmental collapse, nor with respect to the results of the clinical assessment at the one-year and two-year follow-up. There was a considerably higher incidence of extrusion of the internal fixation device among the nailed fractures than those treated with screws. The results indicate that Scand screws are a better alternative to Nyström nails in the treatment of femoral neck fractures. If an adequate reduction cannot be achieved, primary hip replacement is recommended.