The Official journal of the China Association of Rehabilitation of Disabled Persons and the 88th Hospital of PLA

Composite Impact Factor:

0. 948 (2015)

Total citation frequency: 3868 (2015)


ISSN 1005-8478

CN 37-1247/R

Comparison of three surgical procedures for displaced femoral neck fractures in elderly

Author : YANG Fei, HU Li-ting,ZHANG Xing-sheng.     
Working unit : Department of Orthopedic Surgery, Yanqing District Hospital, Beijing 102100, China
Page : 1850-1855.
Key words : elderly, femoral neck fractures, internal fixation (IF) , hemiarthroplasty (HA) , total hip arthroplasty (THA)
Abstract: [Objective] To compare the clinical outcomes of three surgical procedures for Garden type III and IV displaced femoral neck fracture in the elderly. [Methods] A retrospective study was done on 150 patients who were more than 65 years,and underwent surgical treatment for displaced femoral neck fractures. According to the surgical procedures performed, 51 patients had internal fixation with cannulated screws ( the IF group) , 43 patients received hemiarthroplasty (the HA group) , while the remaining 56 patients underwent total hip arthroplasty (the THA group) . The operation time, intraoperative blood loss, postoperative drainage, hospitalization time, hospitalization cost, weight- bearing time and postoperative hip function assessed by Harris score were compared among the three groups. [Results] All the patients in the three groups had surgical procedures performed successfully without serious complications, such as neurovascular injuries in anyone of them. In term of the operation time, intraoperative blood loss, postoperative drainage and hospitalization expenses, the three groups were ranked from low to  high as follows: IF than the HA and THA groups (P<0.05) . The patients were follow up for 36~60 months with an average of (48.767.96) months. At 3, 36 and 60 months postoperatively, the Harris score was arranged from poor to excellent as follows:IF. To the end of follow up, 8 of the 51 patients in the IF group were definitively diagnosed of avascular necrosis of the femoral head or fracture nonunion, and then surgically revised by HA in 2 and THA in 6 patients respectively. Among the 43 patients of the HA group, 1 patient suffered from Vancouver type B1 periprosthetic fracture with proper stability, and subsequently recovered well after internal fixation with plate and titanium cerclages; other 3 patients underwent revision THA due to pain and dysfunction secondary to acetabular wear by the femoral component. Of the 56 patients in the THA group, 1 patient got traumatic dislocation, and latterly restored well after closed reduction and brace immobilization for 8 weeks, another patient suffered from delayed deep infection, which subsided after debridement and antibiotic therapy. [Conclusions] The THA achieves the best clinical outcome for displaced femoral neck fracture in elderly, compared with those of IF or HA.
summary:
Comparison of three surgical procedures for displaced femoral neck fractures in elderly   
YANG Fei, HU Li-ting,ZHANG Xing-sheng.
Orthop J Chin, 27(20):   1850-1855.