Complications of femoral neck fracture fixation using a sliding hip screw with a side plate device in patients older than 65 years (original) (raw)
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Hip International
Introduction: Although the preferred treatment for displaced femoral neck fractures in the elderly is hip arthroplasty, the treatment for impacted or undisplaced femoral neck fractures (UFNF) is still a subject of controversy. Our purpose was to systematically review studies of elderly patients with UFNF treated with internal fixation using screws: (i) what is the reported mortality; (ii) what is the reoperation rate; (iii) what are the clinical and radiological outcomes; and (iv) what is the methodological quality of the included studies? Methods: This systematic review was performed through a search of PubMed and the Cochrane database using a structured search algorithm including studies enrolling patients older than 60 years old, with UFNF treated with internal fixation using screws. Our literature search returned 950 studies and 11 were selected for final abstraction. Results: 6 studies reported mortality rate. At 1-year follow-up mortality was reported by 3 studies: 18.8%; 22%,...
Injury
Introduction: Intracapsular femoral neck fractures remain associated with high rates of post-traumatic femoral head necrosis, non-union, and revision surgery. Aim: Our aim was to identify factors associated with revision surgery in intracapsular femoral neck fractures treated with sliding hip screws (SHS) in adults aged <65 years. Patients and methods: Consecutive admissions were identified retrospectively from the Royal Victoria Hospital, Belfast, which was the largest volume hospital on the National Hip Fracture Database. Of 2201 hip fractures between 1st August 2008 and 31st December 2010, 97 (4%) intracapsular fractures treated with SHS in adults <65 years were followed for a mean of 2.9 years (range 0-6.6). Results: Twenty-one (22%) hips were revised to arthroplasty. Avascular necrosis developed in 28 (29%) femoral heads. Eight (8%) fractures proceeded to non-union. Displaced fractures (p < 0.001, Fisher's exact [FE]), posterior comminution (p = 0.049, FE), chronic respiratory disease (p = 0.006, FE) and residual distraction (p = 0.011, x 2) were associated with revision to arthroplasty. Multiple regression found displaced fractures (p = 0.006) and chronic respiratory disease (p = 0.017) significant; in the latter 4 of 6 were revised (67%), including all four patients with chronic obstructive pulmonary disease (COPD). Eleven (11%) individuals required walking aids before injury, which rose to 34 (35%) at one year (p < 0.0001, x 2). Eighty-nine (92%) individuals could walk alone outdoors before injury, but only 76 (78%) at one year (p = 0.009, x 2). Conclusions: Displaced fractures in individuals with chronic respiratory disease should be considered high risk for revision to arthroplasty. Posterior cortex deficiency should be evaluated prior to choice of operation. Fracture biology and revascularisation play a greater role than operation timing. A significant proportion of individuals do not recovery pre-morbid mobility by one year. Crown
Arthroplasty versus internal fixation for femoral neck fractures in the elderly
Strategies in trauma and limb reconstruction (Online), 2011
We studied 140 patients with femoral neck fractures treated from January 1999 to December 2006. There were 68 men and 72 women with a mean age of 72 years (range 60-80 years). Seventy patients were treated with closed reduction and internal fixation (group A), and 70 patients with hip arthroplasty (group B). The duration of surgery, length of hospitalization, complications, postoperative Harris hip score, and need for reoperation were recorded. Group B had significantly higher blood loss, increased surgical time and length of hospitalization compared to group A patients. The Harris hip score was significantly higher in group B at the 3, 6, and 12-month follow-up evaluations; however, the differences were no longer significant at the 24-month evaluation. The overall complications rate was 18.6% (13 patients) in group A compared to 25.7% (18 patients) in group B; this was not statistically significant (P = 0.309). A statistically significant difference was found regarding reoperation ...
Clinical orthopaedics and related research, 2014
Femoral neck fractures are a major public health problem. Multiple-screw fixation is the most commonly used surgical technique for the treatment of stable femoral neck fractures. We determined (1) the proportion of hips that had conversion surgery to THA, and (2) the proportion of hips that underwent repeat fracture surgery after percutaneous screw fixation of stable (Garden Stages I and II) femoral neck fractures in patients older than 65 years and the causes of these reoperations. We performed a retrospective study of all patients older than 65 years with stable femoral neck fractures secondary to low-energy trauma treated surgically at our institution between 2005 and 2008. We identified 121 fractures in 120 patients older than 65 years as stable (Garden Stage I or II); all were treated with percutaneous, cannulated screw fixation in an inverted triangle without performing a capsulotomy or aspiration of the fracture hematoma at the time of surgery. The average age of the patients...
Failure of femoral neck fracture fixation in younger patients
International Journal of Research in Orthopaedics
Background: Failure of femoral neck fracture fixation in younger patients frequently lead to significant morbidity. This study aims to evaluate the associated risk factors, to help achieve better outcomes.Methods: Records of 25 men and 6 women aged 23 to 50 (mean, 39.8) years who underwent fixation for femoral neck fractures using cancellous screws (n=29), a dynamic hip screw (n=1), or a locking plate (n=1) were reviewed. Patients with or without fixation failure were compared.Results: The mean follow-up period was 28.4 (range, 24–38) months. Of the 31 patients, 24 had bone union and 7 had fixation failure secondary to non-union (n=1), screw cut-out (n=4), and avascular necrosis (n=2). The Revised Trauma Score on admission was 4 in one patient with fixation failure and >6 in all other patients. Comparing patients with or without fixation failure, excess alcohol consumption (5/7 vs. 6/24, p=0.024), smoking (6/7 vs. 9/24, p=0.025), and operative time in minutes (57±16 vs 108±58, p=...
Dynamic Hip Screw for the Treatment of Femoral Neck Fractures: A Prospective Study with 96 Patients
ISRN Orthopedics, 2014
Objectives. To study the correlation between avascular necrosis and the demographics, time elapsed from fracture to surgery, quality of reduction, Garden classification, and the position of the screw following use of the dynamic hip screw (DHS) in the treatment of subcapital neck fractures. Methods. A prospective study of 96 patients with subcapital neck fractures was carried out in a faculty hospital. Patients underwent surgery with closed reduction and internal fixation with DHS. Results. There were 58% male and 42% female patients, with a mean age of 53 years (+/−14). In terms of Garden classification, 60% were Garden IV, 26% were Garden III, and 14% were Garden II. Nonunion was observed in three cases (3%) and was treated with valgus intertrochanteric osteotomy, in all cases leading to successful healing. Avascular necrosis was observed in 16% of patients. The positioning of the screw into the femoral head showed a significant correlation with necrosis. Conclusions. The incidence of necrosis in patients under the age of 50 years is twice as high as that in older patients. Displacement is a predictive factor regarding osteonecrosis and is associated with a high and anterior position of the screw in the femoral head. Level II of evidence. Study Type: therapeutic study.
The Journal of Bone and Joint Surgery, 2003
The treatment algorithms for displaced fractures of the femoral neck need to be improved if we are to reduce the need for secondary surgery. We have studied 102 patients of mean age 80 years, with an acute displaced fracture of the femoral neck. They were randomly placed into two groups, treated either by internal fixation (IF) with two cannulated screws or total hip replacement (THR). None showed severe cognitive dysfunction, all were able to walk independently, and all lived in their own home. They were reviewed at four, 12 and 24 months after surgery. Outcome measurements included hip complications, revision surgery, hip function according to Charnley and the health-related quality of life (HRQoL) according to EuroQol (EQ-5D). The failure rate after 24 months was higher in the IF group than in the THR group with regard to hip complications (36% and 4%, respectively; p < 0.001), and the number of revision procedures (42% and 4%, p < 0.001). Hip function was significantly bet...
Trends in surgical treatment of femoral neck fractures in the elderly
Einstein (Sao Paulo, Brazil), 2018
To analyze recent demographic and medical billing trends in treatment of femoral neck fracture of American elderly patients. The American College of Surgeons National Surgical Quality Improvement Program database was analyzed from 2006 to 2015, for patients aged 65 years and older, using the Current Procedural Terminology codes 27130, 27125, 27235, and 27236. Patient demographics, postoperative complications, and frequency of codes were compared and analyzed over time. Our sample had 17,122 elderly patients, in that, 70% were female, mean age of 80.1 years (standard deviation±6.6 years). The number of cases increased, but age, gender, body mass index, rates of diabetes and smoking did not change over time. Open reduction internal fixation was the most commonly billed code, with 9,169 patients (53.6%), followed by hemiarthroplasty with 5,861 (34.2%) patients. Combined estimated probability of morbidity was 9.8% (standard deviation±5.2%), and did not change significantly over time. Po...