Functional Outcome of Intertrochanteric Fracture (Kyle’s Type 1 and 2) Treated with Dynamic Hip Screw

<p class="abstract"><strong>Background:</strong> Intertrochanteric fractures are one of the commonly occurring injuries in elderly patients and are high among females and those with osteoporosis. They were treated with either dynamic hip screw (DHS) fixation or proximal femoral nailing (PFNA2) here at our institution. The study was conducted in order to find which method of surgical fixation has better functional outcome. </p><p class="abstract"><strong>Methods:</strong> Total 96 patients of intertrochanteric fractures admitted during the study period of November 2017 to April 2019 were included for the study. These patients were randomly divided into two groups; DHS was used as implant in group1 and PFNA2 in group 2. Postoperatively patients were followed up after 1 month, 3months and 6 months of the surgery and were assessed using Harris hip score.<strong></strong></p><p class="abstract"><strong>Results:</strong> Harris hip score was higher with PFNA2 group compared to DHS group in all follow-ups. In unstable fractures DHS group had poor outcome compared to PFNA2. Radiological union occurred in 27.1 % cases by 3 months and 72.9% cases by 6 months with DHS whereas 70.8% and 97.9% respectively with PFNA2. </p><p class="abstract"><strong>Conclusions:</strong> PFNA2 gives a better functional outcome when compared to DHS. Even though DHS gives good functional outcome in stable fractures it is not so in the case of unstable fractures. The radiological union also is faster with proximal femoral nailing. Hence in our opinion PFNA2 can be the better fixation device compared to DHS especially in unstable fractures. </p>

IntroductionIntertrochanteric fractures are the most frequently operated fracture type and have the highest postoperative fatality rate. The most commonly used devices are the dynamic hip screw (DHS) with side plate assemblies and proximal femoral nail (PFN). The aim of this study was to determine the functional and radiological outcome of unstable intertrochanteric fracture post DHS fixation at a tertiary care hospital in Karachi, Pakistan.MethodsA study was carried out in the department of orthopedics at the Jinnah Postgraduate Medical Center (JPMC), from 12th June 2016 to 8th September 2017. A total of 106 patients between 18 and 75 years of age with unstable intertrochanteric fracture were included. Those patients who had multiple injuries and open fractures, subtrochanteric fractures, intracapsular fractures neck of femur, pathological fractures and patients who were non-ambulatory prior to their injury were excluded. Functional outcomes were measured both during pain using the visual analog scale and range of motion on goniometer between 80 and 100 degrees. Satisfactory outcomes were measured after three months.ResultsA total of 106 patients with the radiological diagnosis of the unstable intertrochanteric fracture having post DHS fixation were included in this study. Out of which, 69.8% (74) were males and the mean age was 66.61 ± 7.79 years over the range of 50 to 80 years. Patients with type II diabetes were 22.6% (24) with a mean duration of 4.3 ± 8.37 years. At the end of three months, no pain was reported in 82.1% (87) patients and 85.8% (91) patients had normal function. The satisfactory radiological outcome was observed in 86.8% (92) patients. Overall, acceptable outcomes were observed in 81.1% (86) patients at the end of three months.ConclusionThe treatment of unstable intertrochanteric fracture with dynamic hip screw (DHS) fixation results in better outcomes. In our study, we observed acceptable outcomes in a vast majority, 81.1%, of patients after three months of DHS fixation of the unstable intertrochanteric fracture.

Background: Dynamic hip screw (DHS) is a standard device for intertrochanteric fractures (ITF). Implant failure in form of screw cut out leading to varus collapse of neck shaft angle is associated with various factors like bone quality, fracture pattern, fracture reduction, lateral femoral wall thickness (LFWT), screw position and tip-apex distance (TAD). But there has been no clear consensus to the relative importance of each factor. The purpose of our study is to assess individual factors for a favorable outcome in DHS fixation of ITF. Materials and methods: 121 hips sustaining ITF treated with DHS between June 2014 and July 2016 were reviewed in our prospective study with a mean period of 12 months. Factors under study were bone quality,fracture pattern, fracture reduction, LFWT, screw position and TAD, which were recorded and used for statistical analysis using SPSS. Chi-square test, Independent t-test and Paired t-test were used to evaluate the significance of the differences. Final analysis involved clinical and radiological assessment using Harris Hip Score (HHS) and radiographs respectively. Results and Analysis: The mean age of patient at the time of surgery was 65.27±3.21 years (range 24-85) with 80 males and 41 females. There was no statistical significant relation found between implant failure and osteoporosis even though cases of failure were found in weak osteoporotic bones. Implant failure in relation to unstable fracture pattern, non-anatomical fracture reduction, LFWT< 21.77 mm, screw placement in position apart from centre or centre-inferior and TAD greater than 25mm was found to be statistically significant (p<0.05).The final functional and radiological assessment revealed 68.85% and 86.88% of hips respectively in good to excellent category. Conclusion: DHS is a well-accepted implant for ITF with lower rate of complications only if proper surgical technique is followed. Good fracture reduction, adequate LFWT, ideal screw position and TAD less than 25mm are must to prevent implant failure. Level of Evidence: Level IV Keywords: Intertrochanteric fractures, DHS, Factors for failure

Background: Among the different fixation procedures for intertrochanteric fractures, dynamic hip screw fixation is the most used therapy. Present study evaluated the risk factors affecting the outcome of intertrochanteric fractures managed by dynamic hip screw fixation. Methods: This was an observational retrospective study conducted between March 2021 and February 2022. Patients with intertrochanteric fractures aged &gt;60 years presenting within a week after incurring the fractures were enrolled. Evan’s and AO/OTA classification were used to categorize patients. “Failed” surgery was considered based on one of the following radiographic criteria. Functional outcomes were assessed at 6-months by Harris hip score (HHS). Results: 40 patients were enrolled, majority being females (n=22, 55%) with mean age of 67.79±4.76 years. Commonest mode of injury was fall while standing (n=32, 80%). Based on Evans classification, majority cases were stable fractures (n=25, 62.5%). By the AO/OTA classification, majority patients were under A2 class (n=22, 55%). The 30 cases (75%) had outstanding to good outcomes based on HHS assessment. 8 patients (20%) had “failed” surgical outcomes of which commonest presentations were &gt;20 mm lag screw pull-out (n=4, 10%) and mal union (n=2, 5%). Mean age, and number of obese patients were found to be significantly greater in the “failed fracture” subgroup, versus “united fracture” subgroup (p&lt;0.05). Significantly greater number of cases in “failed fracture” subgroup belonged to Evans’ class IV or V, and to A3 class of AO/OTA classification (p&lt;0.05). Conclusions: Patient factors like greater age, obesity and intertrochanteric unstable fractures as indicated by Evans’ and AO/OTA classification were risk factors affecting the outcome of intertrochanteric fractures, managed with dynamic hip screw.

Fractured neck of femur is a common problem seen in elderly osteoporotic females, mostly in Western countries, among which are the extra-capsular fractures such as intertrochanteric and pertrochanteric fractures also known as peritrochanteric fractures, and commonly treated with dynamic hip screw (DHS) or compression hip screw (CHS). The DHS is based on tension band principle and allows the screw to slide within the barrel to enable compression of the fracture when the patient begins to bear weight. This principle only works in the presence of intact medial wall and so cannot be successful in a reverse oblique fracture of the proximal femur. However, it is important that the technique of screw placement is precise and should ideally be central in the femoral neck, on both AP and lateral radiographs. This is why the concept of tip apex distance (TAD) is critical to the outcome of fixation and can accurately predict failure or survival of the screw. A systematic review of articles published in PubMed/Medline, from 1991 to 2011 (twenty years), was carried out to critically analyse common practice with regards to DHS fixation of extra-capsular femoral neck fractures, and review the recommendations of previous authors, with regard to the effect of TAD in DHS fixation. Search words used include TAD, DHS, sliding hip screw, femoral neck fractures, peritrochanteric fractures, tension band principle, fracture collapse, screw cut-out, DHS failure, and failure of fixation. At the end of the review, recommendations and suggestions regarding the ideal techniques of placement of DHS screw into the femoral neck will be made in line with current published literature, in order to establish an evidence base for best practice. A total of forty eight (48) published articles were found relevant to the review topic. Most papers suggested that Tip Apex Distance (TAD) is the most important predictive factor for DHS failure, followed by lag screw position, fracture pattern and reduction, patient's age and presence of osteoporosis. Therefore, we recommend proper training of surgeons, as well as attention to detail while performing DHS for intertrochanteric neck of femur fractures.

Background: One of the most common injuries and an important cause of mortality and morbidity in the elderly is intertrochanteric fracture. The dynamic hip screw (DHS) is one of the best procedures for fixation of these fractures; however, using DHS is accompanied by failure risk. Objectives: Therefore, with the purpose of reducing failure risk, this study aimed to evaluate the correlation between post-operation CTD and TAD, NSA changes in patients with intertrochanteric fractures. Methods: In this case series study, patients with intertrochanteric fracture treated with DHS between September 2015 and January 2016 were included. The exclusion criteria were pathologic fracture, multiple fractures, greater trochanter fracture, soft-tissue issues, A3OTA type, patients who missed the follow-up period, history of previous hip fracture or dislocation, and TAD>25mm. Ultimately, 24 patients were included in this study. Two surgeons reviewed the anteroposterior (AP) and lateral (Lat) radiographs. The measures of TAD, CTD, and NSA after six-months of follow-up were assessed. In addition, variables such as demographic data, fracture side, duration of operation, blood loss volume, weight bearing day, and Harris hip score (HHS) were analyzed. The relationship between post-operation CTD and TAD, NSA changes after six months of follow-up was analyzed. All data was analyzed using SPSS 20 software (SPSS, IBM Inc., USA). The significance level for all tests was considered to be 0.05. Results: This study evaluated 24 patients. The mean age of the patients was 69.9 ± 12.00 years, and 15 (62.5%) of them were male. No significant correlations were seen in the collected data, especially CTD and NSA changes after six-months of follow-up (p>0.05). Maximum and minimum TAD values after surgery were 25.6 and 11.0, respectively. Maximum and minimum TAD values at the six-month follow-up were 34.9 and 11.0, respectively. Mean TAD was constant at 19.8±5.3 in postoperative and follow-up measurements. This shows that patients experienced increases in TAD and others experienced decreases in TAD within the six months of follow-up. Conclusion: The results showed that despite the abnormal CTD after surgery, the risk of TAD changes increased. Generally, TAD is a well-established radiographic measurement for predicting the risk of cut-out. CTD and TAD can be used together or separately to predict the risk of DHS screw cut-out in patients with intertrochanteric fractures in future studies.

Significance of Tip Apex Distance in Intertrochanteric Fracture femur managed with Proximal femoral nailing

The incidence of intertrochanteric (IT) fracture is rising because of increase in the survival of the elderly population with osteoporosis and also the increase in the number of motor vehicle accidents. The treatment of choice is normally surgical with internal fixation. The surgical options for these fractures commonly include fixation with dynamic hip screw (DHS) or cephalomedullary nailing. Due to its advantages over DHS, cephalomedullary nailing is the predominant procedure in many parts of the world. Various varieties of cephalomedullary nails are available. Short cephalomedullary nails are indicated for IT fractures not extending beyond lesser trochanter. There are limited studies on the comparison of short cephalomedullary nails for IT fracture. In this study, we are evaluating functional outcome, radiological union and complications of inter-trochanteric fractures of femur treated with three different short cephalomedullary nails: (1) Proximal femoral nail (PFN)-standard, (2) modified short PFN (MS-PFN) and (3) PFN-A2 of 240 mm. Our study is a randomized control trial. Subjects are patients with IT fracture presenting to Srinivas Institute of Medical Sciences and Research Centre. After obtaining informed and written consent, as per inclusion and exclusion criteria, subjects are randomized into three groups (simple randomization) and treated with standard PFN (240 mm length), MS-PFN (180 mm length), and PFN-A2 of length 240 mm as per randomisation. Duration of the surgery and total intraoperative blood loss is noted. Patients are followed up till 1-year post-operative period, in different intervals. Functional outcome using Harris hip score, fracture union, complications are assessed and compared. Considering the lost to follow-up, the final study size obtained is 75 (25 in each group). In our study, the average age of the patients is 71.29 years with male predominance and right-side predominance. Majority of the fractures belong to Type 1 Group 2 and type 1 Group 4 of Evan's classification. The average operating time and average intraoperative blood loss is less in PFN-A2 group compared to PFN and MS-PFN groups. The fracture union time is earlier in PFN A2 group compared to PFN and MS-PFN group. Functional outcome is better in PFN-A2 group compared to PFN and MS-PFN groups. In PFN group and PFN A2 of 240 mm length group, there were significant patients with anterior thigh pain. Among 75 patients, 3 in PFN group, 2 in MS-PFN group, and 1 in PFN-A2 group had >1 cm of shortening. 2 patients in PFN group and 1 in MS-PFN group had complication of screw cut-out; 2 in PFN group and 2 in PFN-A2 group had surgical site infection; 1 in PFN group and 1 in PFN-A2 group had varus collapse; and 1 in PFN group and 2 in MS-PFN group had Z effect/reverse Z effect. In our study, on comparing three short nails - PFN, MF-PFN, and PFN-A2, PFN-A2 is superior in terms of operating time, intraoperative blood loss, functional outcome and fracture union. MS-PFN is next to PFN-A2 in the above parameters. Hence, PFN-A2 is superior to MS-PFN and MS-PFN is superior to PFN. Moreover, to avoid anterior thigh pain, we recommend the use of shorter nails (180 mm).

BackgroundConversion to total hip arthroplasty (CTHA) is a relatively common procedure after a failed dynamic hip screw (DHS) or proximal femoral nail anti-rotation (PFNA) fixation of intertrochanteric fractures, but there have been far fewer reports specifically describing the long-term results of CTHA after failed treatments of stable intertrochanteric fractures with DHS or PFNA. The aim of the present study was to compare the clinical and radiological outcomes of CTHA after failed PFNA or DHS fixations of stable intertrochanteric fractures after a minimum follow-up of 3 years.MethodsBetween January 2005 and April 2014, we retrospectively reviewed 142 active elderly patients treated at our institution (a single institution study). A total of 72 patients (72 hips; 41 women, 31 men; mean age 76.9 years old; range 60–92 years old) who underwent conversion of a failed PFNA to a THA were compared with 70 patients (70 hips; 36 women, 34 men; mean age 75.0 years old; range 60–90 years old) who underwent CTHA after a failed DHS fixation. The mean follow-up periods were 48 (range 43–52) and 48 (range 44–52) months for the DHS and PFNA groups, respectively. Clinical and radiologic evaluations were performed on all patients. The primary outcome was the Harris Hip Score (HHS). The secondary outcomes were the complication rates.ResultsThe Harris Hip Score (HHS) improved from 50.61 ± 3.23 preoperatively to 85.28 ± 4.45 at the last follow-up in the PFNA group and from 51.46 ± 3.90 to 84.50 ± 4.34 in the DHS group, with no significant differences noted between the groups at each follow-up (P > 0.05). However, the complication rate in the converted DHS patients was significantly higher (42.9%) than that in the converted PFNA patients (20.8%; P = 0.003). Thirty-seven PFFs (2.4%) occurred during a mean follow-up of 44.4 months. The incidence of periprosthetic fractures was found to be significantly higher (P = 0.021) for the DHS group (15.7%) than for the PFNA group (4.2%).ConclusionsCTHA after failed DHS fixations of stable intertrochanteric fractures might be associated with a significantly higher complication rate than CTHA after failed PFNA fixations. Therefore, PFNA patients with stable intertrochanteric fractures may be more suitable for CTHA.

Intertrochanteric fractures of the femur represent a significant proportion of hip fractures in the elderly and are associated with considerable morbidity, prolonged rehabilitation, and high healthcare costs. Surgical fixation remains the standard of care, with the aim of achieving early mobilization, stable fixation, and optimal functional recovery. Among the commonly used implants, the Dynamic Hip Screw (DHS) has been a traditional choice for stable fracture patterns, whereas the Proximal Femoral Nail (PFN), an intramedullary device, has gained popularity due to its biomechanical advantages in unstable and osteoporotic fractures. This study compares the functional recovery, complication rates, and radiological results between PFN and DHS in patients with intertrochanteric fractures. Objective: To compare the functional outcomes, operative characteristics, and postoperative complications between patients treated with Proximal Femoral Nail (PFN) and Dynamic Hip Screw (DHS) for intertrochanteric femur fractures. Methodology: A prospective comparative clinical study was conducted on n = 60 patients presenting with intertrochanteric fractures at a Sughra Shafi Medical Complex Hospital Narowal. Patients were randomly allocated into two groups: Group A (PFN, n = 30) and Group B (DHS, n = 30). Inclusion criteria were patients aged ≥50 years with stable or unstable intertrochanteric fractures. Exclusion criteria included pathological fractures, polytrauma, open fractures, and previous ipsilateral hip surgery. Data collected included operative time, intraoperative blood loss, duration of hospital stay, radiographic union time, and postoperative complications. Functional outcomes were assessed at 6 weeks, 3 months, and 6 months using the Harris Hip Score (HHS). Statistical analysis was performed using SPSS 26, with p &lt; 0.05 considered significant. Results: PFN demonstrated significantly lower intraoperative blood loss, shorter surgical duration, and reduced hospital stay compared to DHS (p &lt; 0.05). The mean radiological union time was earlier in the PFN group (13.8 ± 2.1 weeks) compared to the DHS group (16.4 ± 2.7 weeks). Functional evaluation at 6 months revealed a higher mean Harris Hip Score in the PFN group (82.6 ± 8.4) than in the DHS group (76.3 ± 9.1), indicating superior functional outcomes (p = 0.03). Complication rates including screw cut-out and varus collapse were lower in the PFN group. Conclusion: Proximal Femoral Nail provides better biomechanical stability, earlier mobilization, faster fracture union, and superior functional outcomes compared to Dynamic Hip Screw in the management of intertrochanteric femur fractures. PFN should be preferred, especially in unstable fracture patterns.

Valeur de la distance aux limites de la tête fémorale (TAD) dans la prise en charge des fractures intertrochantériennes par clou trochantérien proximal

Background: Proximal femur fractures, particularly intertrochanteric fractures, are common causes of morbidity among elderly patients. Surgical fixation using either a Dynamic Hip Screw (DHS) or a Trochanteric Plate (TP) is the standard of care, although evidence comparing their functional outcomes remains inconclusive. This study aimed to compare the clinical, radiological, and functional outcomes of proximal femur fracture fixation using DHS and TP. Methods: This comparative observational study was conducted at the Department of Orthopedics, Holy Family Red Crescent Medical College Hospital, Dhaka, Bangladesh, from January 2023 to December 2024. A total of 30 patients were equally divided into the DHS (n=15) and TP (n=15) groups. Patient demographics, intraoperative variables, complications, radiological union, and functional outcomes were assessed. Harris Hip Score (HHS) was used to evaluate function at 6 months postoperatively. Data were analyzed using SPSS v25.0, and p&lt;0.05 was considered statistically significant. Results: The mean operative time was significantly shorter in the TP group (58 ± 12 min) than in the DHS group (65 ± 15 min, p&lt;0.001). Radiological union at 12 weeks was slightly higher in the TP group (86.6% vs. 73.3%, p=0.37). Mean HHS was comparable (TP: 90.2 ± 7.5 vs. DHS: 87.5 ± 8.2, p=0.35). The complication rates were low and not significantly different between the groups. Conclusion: Both DHS and TP fixation methods are effective in treating proximal femur fractures. TP fixation may offer minor advantages in terms of operative time and early union, but the functional outcomes at six months are similar.

IntroductionIntertrochanteric fractures are common in the old age group. The goal/aim of the treatment for intertrochanteric fractures will be to nearly restore pre-injury condition as early as it is possible. Dynamic hip screw (DHS) and proximal femoral nailing (PFN) have been the two standard treatment methods used for treating these kinds of fractures. The main goal of this proposed study was to compare functional outcomes of two available fixation devices for inter-trochanteric fracture using Harris hip scoring. The aim of this study is to compare the functional outcome of the DHS and PFN for the treatment of Intertrochanteric hip fractures achieved by the patient based on Harris hip score.Methods and materialsThe clinical methodology for the study consists of 46 cases of Inter-trochanteric fractures of femur that meet the inclusion criteria of patients aged above 45 years diagnosed with closed intertrochanteric fractures that are less than three weeks duration who were able to walk prior to fracture and exclusion criteria, admitted to R L Jalappa Hospital, Tamaka, Kolar between November 2019 and November 2021. The patients were divided into two groups, group A treated with DHS and group B treated with PFN and followed up at six weeks, 12 weeks, and 24 weeks based on the functional outcome on the 24th week using Harris hip score.ResultsA total of 46 patients were included in the study. The mean age in Group DHS was 61.09 ± 11.69 and in Group PFN was 65 ± 14.98. In the group of DHS, nine out of 23 patients were male and 14 out of 23 patients were female patients. In a group of PFN, 12 out of 23 patients were male and 11 out of 23 patients were female. The mean six weeks score in Group DHS was 34.43 ± 3.23 out of 100 and in Group PFN was 34.35 ± 2.5 out of 100. The mean Harris hip score in Group DHS was 84.3 ± 7.68 out of 100. The mean Harris hip score in Group PFN was 89.26 ± 6.53 out of 100. In Group DHS, 52.17% had injuries on the left side and 47.83% had on the right side. In Group PFN, 39.13% had Injury on the left side and 60.87% had on the right side. In Group DHS, results were excellent in 34.78% (eight patients), good in 43.48% (10 patients), fair in 17.39% (four patients out of 23 patients), and poor in 4.35% (one patient). In Group PFN, results were excellent in 56.52% (13 patients), good in 34.78% (eight patients), and fair in 8.70% (two patients).ConclusionFrom the study, it can be concluded that PFN had a better outcome in intertrochanteric fractures compared to DHS. The highest percentage of subjects in the PFN group had excellent to a good outcome and none of them had poor outcomes when compared to the DHS group. PFN group had higher scores of Harris hip score at 12 weeks, 24 weeks, and at the end of follow-up.

Comparative analysis of the functional outcome in intertrochanteric fractures between dynamic hip screw and proximal femoral nailing - A prospective study - IJOS- Print ISSN No: - 2395-1354 Online ISSN No:- 2395-1362 Article DOI No:- 10.18231/j.ijos.2020.043, Indian Journal of Orthopaedics Surgery-Indian J Orthop Surg

Our aim was to determine the best operative procedure in human participants with a displaced or non-displaced femoral neck fracture comparing cannulated screw (CS) fixation, dynamic hip screw (DHS) fixation, hemiarthroplasty (HA), and total hip arthroplasty (THA) in terms of surgical and functional outcomes, reoperation and postoperative complications. We searched PubMed, The Cochrane Library, Clinical trials, CINAHL, and Embase for randomized controlled trials (RCTs) or quasi-RCTs up to 31 July 2022. A frequentist network meta-analysis was performed to assess the comparative effects of the four operative procedures, using fixed-effects and random-effects models. Mean differences (MDs) with 95% confidence intervals (CIs) were estimated for continuous variables and odds ratios (ORs) with 95% CIs were estimated for binary variables. A total of 33 RCTs with 5703 patients were included in our network meta-analysis. CS fixation was best in terms of operation time (CS: MD = - 57.70, 95% CI - 72.78; - 42.62; DHS: MD = - 53.56, 95% CI - 76.17; - 30.95; HA: MD = - 20.90, 95% CI - 30.65; - 11.15; THA: MD = 1.00 reference) and intraoperative blood loss (CS: MD = - 3.67, 95% CI - 4.44; - 2.90; DHS: MD = - 3.20, 95% CI - 4.97; - 1.43; HA: MD = - 1.20, 95% CI - 1.73; - 0.67; THA: MD = 1.00 reference). In life quality and functional outcome, measured at different time points with EQ-5D and the Harris Hip Score (HHS), THA ranked first and HA second (e.g. EQ-5D 2years postoperatively: CS: MD = - 0.20, 95% CI - 0.29; - 0.11; HA: MD = - 0.09, 95% CI - 0.17; - 0.02; THA: MD = 1.00 reference; HHS 2years postoperatively: CS: MD = - 5.50, 95% CI - 9.98; - 1.03; DHS: MD = - 8.93, 95% CI - 15.08; - 2.78; HA: MD = - 3.65, 95% CI - 6.74; - 0.57; THA: MD = 1.00 reference). CS fixation had the highest reoperation risk, followed by DHS fixation, HA, and THA (CS: OR = 9.98, 95% CI 4.60; 21.63; DHS: OR = 5.07, 95% CI 2.15; 11.96; HA: OR = 1.60, 95% CI 0.89; 2.89; THA: OR = 1.00 reference). In our cohort of patients with displaced and non-displaced femoral neck fractures, HHS, EQ-5D, and reoperation risk showed an advantage of THA and HA compared with CS and DHS fixation. Based on these findings, we recommend that hip arthroplasty should be preferred and internal fixation of femoral neck fractures should only be considered in individual cases. a systematic review of randomized controlled trials. PROSPERO on 10 August 2022 (CRD42022350293).