Treatment of displaced subcapital femoral fractures by primary total hip replacement

Abstract

The management of displaced subcapital femoral fractures (Garden grade 3 or 4) remains controversial. Current methods of treatment, such as reduction and internal fixation, or primary prosthetic replacement of the femoral head, have a high complication rate on long term follow-up. In view of the success of total hip arthroplasty in osteo-arthritis, we believe that this procedure may be indicated in young and active patients with displaced subcapital fractures. 46 consecutive patients (mean age 63.5 years) so treated were followed-up for an average of 35.5 months. The complication rate, apart from dislocation, was low. 94% had good or excellent results. Total hip replacement may be indicated in a selected group of such patients, but longer follow-up is necessary to define its overall role in the management of this difficult fracture.