PubMed^® Literature Review

The management of non-displaced neck of femur fractures remains contentious, with options including screw fixation and joint replacement (either hemiarthroplasty or total hip arthroplasty). A critical synthesis of the literature reveals nuanced outcomes dependent on patient demographics, fracture characteristics, and surgical intervention specifics. Wani et al. conducted a prospective cohort study (Level II) comparing internal fixation with cannulated screws versus total hip arthroplasty in patients aged between 60-80 years with displaced femoral neck fractures [1]. They reported superior functional outcomes as measured by Harris hip scores in the arthroplasty group at various follow-up intervals up to 18 months post-surgery [1]. However, McKinley and Robinson's matched-pairs case-control study (Level III) highlighted that early salvage total hip arthroplasty following failed internal fixation resulted in higher complication rates compared to primary arthroplasty [3]. Jettoo and James’s large-scale database analysis (Level III) found multiple screw fixation had shorter hospital stays but higher conversion rates to hemiarthroplasty or THA compared to dynamic hip screw (DHS) fixation [2]. Parker's pilot randomised trial among elderly men indicated that cemented hemiarthroplasty was associated with fewer reoperations compared to internal fixation using Targon Femoral Plate for displaced intracapsular fractures [4]. In contrast, Parker et al.’s comparison between internal fixation for undisplaced intracapsular fractures versus hemiarthroplasty for displaced fractures revealed benefits such as shorter operation time and reduced peri-operative complications favoring internal fixation [5]. Warschawski et al.'s comparative study showed no significant differences in complication rates or clinical outcomes when treating nondisplaced intracapsular hip fractures with either dynamic locking plate or simple cannulated screws [6]. Talboys et al.’s retrospective cross-sectional study suggested that total hip replacement might be more favorable than internal fixation regarding function and pain relief for patients aged 50-75 years suffering from displaced intracapsular fractures; however they noted no significant difference for undisplaced fracture treatment modalities [7]. García-Alvarez et al.'s prospective study identified risk factors predisposing infection postoperatively after Thompson arthroplasty for subcapital hip fracture but did not compare different surgical interventions directly related to our query [8]. Mouzopoulos et al., through their randomized division into three groups receiving different surgical treatments for displaced subcapital hip fracture over age 70 years old found better functional results after four years follow-up favoring total arthroplasties over both hemi-arthroplasties and internal fixations using Richards plates screws[9]. These findings collectively suggest an individualized approach considering patient age, activity level, comorbidities alongside specific fracture patterns is crucial when deciding on optimal management strategy between screw fixation versus joint replacement.