Outcome in patients with femoral neck fractures depends on the treatment used
Abstract
Background: Hip fractures among the elderly are related to a high degree of mortality and disability. The views of the treatment methods of elderly patients with femoral neck fractures are opposing.
Patients and methods: In the 4-year period the General and Teaching Hospital Celje admitted 164 patients older than 65 years for treatment due to a dislocated femoral neck fracture (Garden 3,4). The patients were divided into two groups according to the fracture management approach. 52 patients were treated for dislocated femoral neck fracture through internal fixation with three screws (Group A). 81 patients were treated for dislocated femoral neck fracture through cemented bipolar partial prosthesis (Group B). The one-year survivability was examined and compared between the two groups. A multivariant analysis was used to examine the impact on the final outcome of the treatment and one-year survivability.
Results: A good treatment outcome was reported in 44 % elderly managed with osteosynthesis and in 66 % patients treated with prosthesis. A cumulative one-year survivability rate was 64.6 % in patients treated with osteosynthesis while in patients treated with prosthesis the rate was 75.7 %. The pre-fracture medical condition (3.88 odds ratio), treatment approach (0.33 odds ratio) and clinical rehabilitation efficiency (0.07 odds ratio) had a statistically significant impact on the functional one-year post-fracture result. The age of the patients (0.30 odds ratio) and hospital rehabilitation efficiency (2.89 odds ratio) had a significant impact on the post-fracture survivability.
Conclusions: The authors claim that a primary cemented partial bipolar prosthesis is the treatment choice for elderly with dislocated femoral neck fracture.
Downloads
References
Beck A, Ruter A. Schenkelhalsfrakturen – Diagnostik und therapeutisches Vorgehen. Unfallchirurg 1998; 101: 634–48.
Koval KJ, Skovron ML, Aharonoff GB, Zuckerman JD. Predictors of functional recovery after hip fracture in the elderly. Clin Orthop 1998; 348: 22–8.
Hudson JI, Kenzora JE, Hebel JR, Gardner JF, Scherlis L, Epstein RS, Magaziner JS. Eight-year outcome associated with clinical options in the management of femoral neck fractures. Clin Orthop 1998; 348: 59–66.
Chua D, Jaglal SB, Schatzker J. An orthopedic surgeon survey on the treatment of displaced femoral neck fractures: opposing views. Canadian Journal of Surgery 1997;40: 271–7.
Swiontkowski MF. Intracapsular hip fractures. In: Browner BD, Jupiter JB, Levine AM, Trafton PG, eds. Skeletal trauma. Phyladelphia: Saunders; 1992. p. 1369–442.
McGann WA. Surgical approaches. In: Callaghan JJ, Rosenberg AG. Rubash HE, eds. The adult hip. Lipnicot Raven Publishers; 1997.
Camporesi EM, Greeley WJ, Lumb PD, Watkins WD. Anesthesia. In: Sabiston DC, ed. Textbook of Surgery. Philadelphia: Saunders; 1991. p. 156.
Mathews DE, Farewell VT. Using and understanding medical statistics. Basel: Krager;1985.
Glantz SA, Slinker BK. Primer of applied regression and analysis of variance. New York: McGraw Hill; 1990.
Berglund-Roden M, Swierstra BA, Wingstrand H, Thorngren K. Prospective comparison of hip fracture treatment. 856 cases followed for 4 months in The Netherlands and Sweden. Acta Orthop Scand 1994; 65: 287–94.
Robinson CM, Saran D, Annan IH. Intracapsular hip fractures. Results of management adopting a treatment protocol. Clin Orthop 1994; 302: 83–91.
Chua D, Jaglal SB, Schatzker J. Predictors of early failure of fixation in the treatment of displaced subcapital hip fractures. J Orthop Trauma 1998; 12: 230–4.
Elmerson S, Sjostedt A, Zetterberg C. Fixation of femoral neck fracture. A randomized 2 year follow-up study of hook pins and sliding screw plate in 222 patients. Acta Orthop Scand 1995; 66: 507–10.
Palmer SJ, Parker MJ, Hollingworth W. The cost and implications of reoperation after surgery for fracture of the hip. J Bone Joint Surg 2000; 82A: 864.
Van Vugt AB, Oosterwijk WM, Goris RJ. Osteosynthesis versus endoprosthesis in the treatment of unstable intracapsular hip fractures in the elderly. A randomised clinical trial. Arch Orthop Trauma Surg 1993; 113: 39–45.
Michele JP, Hoffmeyer P, Klopfenstein C, Bruchez M. Prognosis and functional recovery 1 year after hip fracture: Typical patient profiles through cluster analysis. J Gerontol 2000; 55A: 508–17.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
