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Open reduction internal fixation
1%
18/2012
Bipolar hemiarthroplasty
8%
155/2012
Total hip arthroplasty
88%
1769/2012
Unipolar hemiarthroplasty
3%
55/2012
Traction and non operative treatment
0%
3/2012
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The answer is total hip arthroplasty (#3).Both references suggest that elderly active individuals should be treated with a primary total hip after displaced femoral neck fractures. Keating et al randomized 207 patients to be either treated with ORIF, bipolar hemiarthroplasty, or total hip arthroplasty. There was no mortality difference among the three groups, however the rate of secondary surgery was highest in the ORIF group (39% compared with 5% in the group treated with bipolar hemiarthroplasty and 9% in the group treated with total hip replacement). Furthermore, the fixation group had the worst hip-rating-questionnaire and EuroQol scores at four and twelve months. Tidermark et al in a randomized controlled trial, studied the difference between ORIF and total hip replacement in 102 patients. The total hip replacement group showed a lower overall complication rate (36% versus 4%) and higher hip function scores in regard to pain, movement and walking. Illustration A shows the division of proximal femur fractures according to location.
3.2
(39)
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