This RCT enrolled 222 elderly patients (mean age 83, 74% women) with displaced intracapsular femoral neck fractures and randomized them to closed reduction with two parallel cannulated screws (n=112) or bipolar cemented hemiarthroplasty (n=110), with blinded functional assessment at 4, 12, and 24 months. The primary outcome was Harris hip score at 12 months.
When you see a displaced intracapsular femoral neck fracture (Garden III/IV) in an ambulatory patient over 60, hemiarthroplasty is the default — not because fixation always fails, but because even when it succeeds, function is worse.
Reserve internal fixation for young, physiologically robust patients where preserving the native femoral head is worth the 35–40% reoperation risk.
This RCT enrolled 222 elderly patients (mean age 83, 74% women) with displaced intracapsular femoral neck fractures and randomized them to closed reduction with two parallel cannulated screws (n=112) or bipolar cemented hemiarthroplasty (n=110), with blinded functional assessment at 4, 12, and 24 months. The primary outcome was Harris hip score at 12 months.
When you see a displaced intracapsular femoral neck fracture (Garden III/IV) in an ambulatory patient over 60, hemiarthroplasty is the default — not because fixation always fails, but because even when it succeeds, function is worse.
Reserve internal fixation for young, physiologically robust patients where preserving the native femoral head is worth the 35–40% reoperation risk.