Treatment options for displaced femoral neck fractures in elderly patients

Abstract

There are few studies known about the influence of different surgical procedures in patient mortality and postoperative outcome in these kinds of patients. In this study we compare the outcome of cannulated hip screws (CHS) with hemiarthroplasty (HA) for management of intra-capsular femoral neck fractures in elderly with severe systemic conditions. Material. Methods. We conducted a retrospective cohort study of all patients admitted to our trauma center with a femoral neck fracture between January 2009 and June 2011. Inclusion criteria are: 70 years or older, ASA 3 or higher, a displaced femoral neck fracture and treatment with either three cannulated hip screws or a cemented hemiprosthesis. The primary outcomes was mortality during follow up. Secondary outcomes were post-operative complications, re-operations rate and length of hospital stay. We tracked this using the Romanian personal registration system. Results Between the first of January 2010 and December 2012, underwent 326 patients a surgical procedure for an intra-capsular femoral neck fracture: 173 underwent hemiarthroplasty (HA), 11 underwent total hip replacement (THR), 96 underwent closed reduction and internal fixation with Canulated Hip Screws (CHS) and 46 underwent closed reduction and internal fixation with Dynamic Hip Screw (DHS), 74 patients met our inclusion criteria. The medical records retrieved 34-64 months after surgery. There were significantly more implant related complications in CHS than HA group (31.6% vs. 9.1% respectively, P=0.009). Rate of serious general complications did not different between two groups (21.1% vs 36.4% respectively, P=0.27). Conclusions We believe that a hemiarthroplasty is appropriate for treatment of displaced intra-capsular femoral neck fracture in elderly. The CHS is associated with more implant related complications than HA in treatment of a displaced femoral neck fracture in elderly patients with ASA 3 or 4.