Description

A retrospective review of fifty patients treated by closed reduction and internal fixation with a compression hip screw, and fifty patients treated with an uncemented Moore’s hemiarthroplasty was performed. All patients were 60 years of age or greater. Each patient’s preoperative mobility, place of residence and associated medical conditions were recorded. Assessment of mental status was classified as demented, mildly confused or normal. Mean age was 82 years and mean follow-up was 1.5 years. Demented patients had a significantly higher mortality when treated with internal fixation. There was a high incidence of complications in both groups (26% in those patients treated with hemiarthroplasty and 64% in those treated with closed reduction and internal fixation.) Fifty-one percent of internal fixation patients required revision at one year compared with 8% of hemiarthroplasty patients. All (seven) demented patients treated with internal fixation required revision surgery within one year. Altered mental function confers increased mortality and morbidity on fractured neck of femur patients treated with internal fixation, and we advocate hemiarthroplasty as an appropriate treatment in such compromised patients.