Outcome analysis of osteosynthesis versus hemiarthroplasty for the treatment of displaced femoral neck fracture in young elderly patients of Northern India

Objective: The objective of this study lies in the outcome analysis of osteosynthesis versus hemiarthroplasty for the treatment of displaced femoral neck fracture in young elderly patients of northern India. Study Design: Retrospective study. Setting and Duration: This study was conducted at the Department of Orthopaedics, Institute of Medical Sciences, Benaras Hindu University (BHU), at a trauma center setting from January 2015 to January 2017 and were followed up for an average duration of 12 months. Methods: Patients of displaced neck of femur fracture (Pauwell's Types III and IV) divided into two groups who were treated with osteosynthesis with cannulated cancellous screws versus hemiarthroplasty at a trauma center, BHU, were considered for this study, and their retrospective data were analyzed for the incidence of union, infection, functional outcome, and complications in the osteosynthesis versus hemiarthroplasty group. Out of a total of 84 patients studied, 40 belonged to the osteosynthesis group and 44 belonged to the hemiarthroplasty group. Results: In terms of functional outcome, the hemiarthroplasty group consistently outperformed the osteosynthesis group using Harris Hip Score and Palmer and Parker mobility score. This difference was found statistically significant (P = 0.003). As for the complications, in the osteosynthesis group, 6 patients suffered avascular necrosis of the femoral head and 12 patients suffered nonunion of the femoral head with screw cutout. This led to the reoperation of 16 patients. None of the patients in the osteosynthesis group suffered infection. In the hemiarthroplasty group, one patient suffered infection leading to reoperation and thorough debridement of one hip. Hemireplacement group showed a significantly lower percentage of complication as compared to the osteosynthesis group. Conclusion: It is evident that the functional outcome is much better in the hemiarthroplasty group as compared to the osteosynthesis group in displaced femoral neck fractures. Advantages of hemiarthroplasty are early mobilization and rehabilitation, early return to work as compared to the osteosynthesis group which has higher incidence of nonunion, screw cutout, delayed rehabilitation, and prolonged period of nonweight bearing. A significant disadvantage of osteosynthesis is prolonged immobilization, which has cost implications and loss of daily wages in a low-resource country like India.