Internal Fixation or Joint Replacement Therapy for Aged Hip Fracture Patients

Patients will be enrolled from five study centers, each center will be free with regard to surgical indications and postoperative prescription. The unstable fractures were A2 and A3 (31 A2.2 and 3, and 31 A3.3) according to the AO classification. The investigators will use a prospective randomized approach to determine the treatment procedure for patients. The patients undergoing arthroplasty will be regarded as the experimental group and the patients who accept the intramedullary nail fixation will be regarded as the positive control group. All patients will receive consistent anticoagulant, analgesic and other therapeutic measures in the perioperative period except for the different surgical methods. The two groups will be compared in age, sex, pre-fracture place of residence, fracture type and preoperative comorbidity. The investigators will evaluate the effect and safety of the two types of operations by comparing the surgical related data, complication incidence and functional rehabilitation.

• Joint replacement surgery (Procedure): Joint replacement surgery is to replace the original joint function, so that the patient can recover the joint function as soon as possible.
• Intramedullary nail fixation (Procedure): Internal fixation surgery is the stable fixation of fracture, which provides the condition for the restoration of joint function.

Primary outcomes

• Bleeding related index [Three days after the operation]: Postoperative drainage volume and bleeding volume during operation（Unit: ml）

Secondary outcomes

• Joint rehabilitation index [Three months after the operation]: Early loading time
• Complication rate [Three monthes after the operation]: The incidence of postoperative lung infection, urinary tract infection, bedsore and mortality
• Functional rehabilitation index [Three months after the operation]: Harris Scores of the two groups
• Surgical related index [Three days after the operation]: operation time of the two groups（Unit: minutes）

Sex: All, ages: 75 Years to any

Inclusion Criteria:

* Intertrochanteric fractures of the femur need surgery
* Male and female, age more than 75 years old
* Combined with more than one medical complication, including hypertension, cerebral infarction, respiratory failure, renal insufficiency, coronary heart disease, diabetes, heart failure, pulmonary infection, heart rate, water and electrolyte disorders
* The patient is still able to tolerate surgery through the anaesthesia and related department assessment
* Signed written informed consent

Exclusion Criteria:

* No complications associated with internal medicine
* Mild fracture displacement and conservative treatment required
* Multiple trauma involving more than one organ system
* Known to have progressive malignant neoplasms
* It is not possible for the subjects to follow the test scheme, such as uncooperative attitudes, inability to return to the research centre for follow-up visits and inability to complete the study

• Baoguo Jiang, Doctor, Study director, Peking University People's Hospital