Outcomes and complications of nondisplaced femoral neck fracture treated by screw fixation or hip hemiarthroplasty in elderly patients

Hip fractures impose vast individual and societal burdens. It is, therefore, crucial to optimise treatment of hip fractures and to identify safe and reliable surgical options, tailored to different age groups and hip fracture types. Our target population were geriatric patients with a nondisplaced femoral neck fracture (FNF). We aimed to study if measurements of the posterior tilt (of the femoral head) assessed by hip radiographs were (1) reliable, (2) valid, and (3) influenced by the positioning of the injured hip during imaging. (4) We questioned if patients with a posterior tilt ≥20° had an increased risk of needing a second surgery after screw fixation. (5) Finally, we asked if geriatric patients with nondisplaced FNF could achieve better outcomes if treated with hemiarthroplasty rather than screw fixation. We found that (1) The reliability among eight surgeons that assessed the posterior tilt of 50 nondisplaced FNFs was good (2) That plain radiographs were valid for the assessment of posterior tilt, as compared to measurements done by 3D CT models (3) The positioning of a 3D-printed FNF model did not systematically affect measurements of posterior tilt during imaging. (4) That a preoperative posterior tilt ≥20° significantly increased the risk of needing a reoperation, by retrospective analysis of 322 patients treated with screw fixation. (5) Finally, we conducted a multicentre randomised controlled trial to assess the effect of screw fixation versus hip hemiarthroplasty on hip pain and function, mobility, and reoperations in 219 patients aged 70 years and older with nondisplaced FNF. We found that elderly patients with nondisplaced FNF may benefit from the increased mobility and lower risk of reoperation associated with hemiarthroplasty. Our results have challenged international guidelines that recommend screw fixation for nondisplaced FNF in older patients, and we have suggested a modification of current recommendations accordingly