A Clinical Comparision of Multiple Pinning With Bipolar Endoprosthesis of the Femoral Neck Fractures in the Elderly Patients

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%, and 19%. At 5 years, 1 study reported mortality rate of 42%. Overall reoperation rate was reported by 9 studies and ranged from 8%-19%, while conversion to hip arthroplasty was performed in the range between 8% and 16% according to 6 studies. Conclusions: Internal fixation with cannulated screws for UFNF in the elderly is a valuable option, although it has substantial reoperation and mortality rates. Further prospective high-quality, randomised controlled trials are required to establish the optimal approach for the treatment of UFNF.

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The role of primary cemented total hip arthroplasty in the management of fractures of the neck of femur in the elderly population

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20175066 ◽

2017 ◽

Vol 4 (1) ◽

pp. 8

Author(s):

Yeshwanth Subash ◽

Jagadeesh B. ◽

Ravikrishna R. ◽

Prabhu Manickam

Keyword(s):

Total Hip Arthroplasty ◽

Femoral Neck ◽

Elderly Patients ◽

Hip Arthroplasty ◽

Elderly Population ◽

The Elderly ◽

Femoral Neck Fractures ◽

Total Hip ◽

Cemented Total Hip Arthroplasty

Background: Femoral neck fractures are common injuries in the elderly population and are associated with high rates of morbidity and mortality. The aim of surgical intervention in these elderly patients is to restore them to the pre-fracture status as rapidly as possible. The aim of this study was to evaluate the role of total hip arthroplasty as a primary option in the management of these fractures and to compare the results with studies of other authors as available in literature.Methods: 45 patients with femoral neck fractures treated with cemented total hip arthroplasty were studied from January 2011 to January 2013 and were followed up for a minimum period of two years.Results: There were 18 males and 27 females ranging from 60 to 75 years of age. Mean age was 64.6 years. Majority (80%) of the fractures were completely displaced, Garden type 4 fractures followed by type 3 in 20% of cases. The most common mode of injury was a simple slip and fall. Excellent results were seen in 17 patients, good results in 24 patients and fair results in 4 patients. No poor results were seen. Conclusions: Cemented total hip arthroplasty is a very useful procedure for the primary treatment of femoral neck fractures in elderly patients. This procedure markedly improves the functional status of the patients and gives good functional results.

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CURRENT STATUS OF DIAGNOSIS AND TREATMENT OF FEMORAL NECK FRACTURES IN THE ELDERLY

American Journal of Orthopedic Research and Reviews ◽

10.28933/ajorr-2021-01-0805 ◽

2021 ◽

pp. 19

Author(s):

◽

Keyword(s):

Femoral Neck ◽

Elderly Patients ◽

Elderly Women ◽

The Elderly ◽

Femoral Neck Fractures ◽

Diagnosis And Treatment ◽

Current Status ◽

Treatment Methods ◽

Treatment Status ◽

Treatment Plans

Femoral neck fractures are common fractures in the elderly, especially in elderly women. There are many mature treatment methods for femoral neck fractures. However, which option is better is still controversial. In order to allow clinicians to better develop treatment plans for elderly patients with femoral neck fractures, this article summarizes the diagnosis and treatment status of elderly femoral neck fractures from the aspects of epidemiology, etiology and diagnosis, treatment methods and progress of elderly femoral neck fractures.

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A Nomogram for Predicting 30-day Mortality in Elderly Patients Undergoing Hemiarthroplasty for Femoral Neck Fractures

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459320960087 ◽

2020 ◽

Vol 11 ◽

pp. 215145932096008

Author(s):

Zachary Thomas Crawford ◽

Brendan Southam ◽

Robert Matar ◽

Frank R. Avilucea ◽

Katherine Bowers ◽

...

Keyword(s):

High Risk ◽

Femoral Neck ◽

Elderly Patients ◽

Early Time ◽

Perioperative Period ◽

The Elderly ◽

Femoral Neck Fractures ◽

Multidisciplinary Teams ◽

Chi Square ◽

Geriatric Population

Introduction: Femoral neck fractures in the elderly are increasingly common as a result of a growing geriatric population with 1-year mortality rates approaching 35%. While preoperative medical optimization and early time to surgery have reduced morbidity and mortality, patients with numerous medical comorbidities remain high risk for death in the perioperative period. Identifying those with greatest risk with a scoring system or nomogram may assist multidisciplinary teams in reducing mortality following hemiarthroplasty. Purpose: Identify predictors of 30-day mortality in elderly patients who underwent hemiarthroplasty for a femoral neck fracture to generate a predictive nomogram to determine the probability of post-operative mortality. Methods: Retrospective evaluation using data from the ACS-NSQIP database from 2005 to 2014 with CPT code 27125 for hip hemiarthroplasty. Multiple factors including demographics and comorbidities were compared in patients who experienced 30-day mortality and those who did not. T-test and chi-square tests were used to analyze data and a multivariate model was generated using logistic regression. Results: Advanced age (odds ratio (OR) 1.04), underweight BMI (OR 1.55), male sex (OR 1.80), reduced functional status (OR 2.04), heart failure within 30 days prior to surgery (OR 2.22), American Society of Anesthesiologists grade > 2 (OR > 2.50), disseminated cancer (OR 3.43) were all found to have statistically significant odds ratios for 30-day mortality following hemiarthroplasty. Conclusion: A tool based on easily identifiable risk factors, demographics, and comorbidities was developed that can help predict elderly patients who will experience mortality within 30 days of following hemiarthroplasty. In addition to identifying high risk patients, the nomogram can serve as a counseling tool for physicians to use with patients and their families to assist with better understanding of perioperative mortality risk.

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