This Norwegian multicenter RCT randomized 219 patients aged ≥70 with nondisplaced femoral neck fractures to cannulated screw fixation or hemiarthroplasty. It asked whether arthroplasty should replace internal fixation for these traditionally 'low-risk' fractures. Outcomes included hip function (HHS), mobility (TUG), pain, quality of life, and reoperation rates over 24 months.
Internal fixation has long been the default for nondisplaced femoral neck fractures (Garden I/II) in elderly patients, with arthroplasty reserved for displaced injuries. This trial is the first sufficiently powered multicenter RCT to challenge that dogma directly.
For every 6–7 elderly patients you treat with screws instead of hemiarthroplasty, one will require a major reoperation that could have been avoided. When you see a nondisplaced femoral neck fracture in a patient ≥70, measure posterior tilt on the lateral X-ray before you choose fixation. Posterior tilt ≥20° more than doubles the risk of fixation failure and should push you toward arthroplasty.
Hemiarthroplasty trades a larger index operation and meaningfully higher pulmonary complication risk for a fourfold lower reoperation rate and better functional mobility at 2 years. For ambulatory, home-dwelling patients, the authors note that total hip arthroplasty may be even more appropriate than hemiarthroplasty.
Neither operation restores prefracture function by 2 years — set realistic expectations with patients and families from day one.
This Norwegian multicenter RCT randomized 219 patients aged ≥70 with nondisplaced femoral neck fractures to cannulated screw fixation or hemiarthroplasty. It asked whether arthroplasty should replace internal fixation for these traditionally 'low-risk' fractures. Outcomes included hip function (HHS), mobility (TUG), pain, quality of life, and reoperation rates over 24 months.
Internal fixation has long been the default for nondisplaced femoral neck fractures (Garden I/II) in elderly patients, with arthroplasty reserved for displaced injuries. This trial is the first sufficiently powered multicenter RCT to challenge that dogma directly.
For every 6–7 elderly patients you treat with screws instead of hemiarthroplasty, one will require a major reoperation that could have been avoided. When you see a nondisplaced femoral neck fracture in a patient ≥70, measure posterior tilt on the lateral X-ray before you choose fixation. Posterior tilt ≥20° more than doubles the risk of fixation failure and should push you toward arthroplasty.
Hemiarthroplasty trades a larger index operation and meaningfully higher pulmonary complication risk for a fourfold lower reoperation rate and better functional mobility at 2 years. For ambulatory, home-dwelling patients, the authors note that total hip arthroplasty may be even more appropriate than hemiarthroplasty.
Neither operation restores prefracture function by 2 years — set realistic expectations with patients and families from day one.