Abstract
COMPARATIVE STUDY OF FIXATION AND REPLACEMENT OF INTRACAPSULAR FEMORAL NECK FRACTURES IN ELDERLY PATIENTS

Raed Al-Zaben MD*, Omar S. Bani Ahmad MD, Moayad abu Qa’oud MD, Hamed Abdallah Alsarhan MD, Mohammad Hussein Al-Oun MD

ABSTRACT

Introduction: Femoral neck fractures are the most common type of fracture in the elderly osteoporotic population. The treatment options include internal fixation (IF), total hip replacement (THR) and hemiarthroplasty (HA). Methods: The medical records of 150 elderly patients treated at orthopedic clinics in Jordanian Royal Medical Services hospitals between January 2016 and January 2019 were retrospectively analyzed. The inclusion criteria were elderly patients aged >65 years, intracapsular femoral neck fracture (Garden types I–IV), and the ability to walk independently prior to surgery with or without aids. Patients were treated with either THR (group A), HR (group B) or IF (group C) using cannulated screws, dynamic hip screws or both. The mean follow-up period was 24 months. All patients were alive at January 2019. Results: Most patients were female (101/150, 67%). The length of hospitalization of group A was significantly shorter than groups B and C (5, 7 and 6 days, respectively; P =0.03). Patients in group A also had a significantly better functional score than those in groups B and C (P = 0.025, P = 0.034 and P = 0.04 respectively), along with the lowest rate of postoperative complications (18%, nine patients) and the lowest reoperation rate (2%, one dislocation). Group B had an overall complication rate of 33.3%, with three patients requiring reoperation (5%). Group C had the highest overall complication rate of 47.5% (15 patients), but this difference did not reach statistical significance (P = 0.39). Group C also had a significantly higher reoperation rate (17.5%, P = 0.045) due to nonunion in five patients and avascular necrosis in two patients. Conclusion: Treatment of the femoral neck fracture with THA was associated with a significantly shorter length of hospitalization, better functional scores and lower complication and reoperation rates. On the other hand, IF had a significantly shorter operation time but the highest rate of reoperation. The HA group had more medical complications, but this was not statistically significant.

Keywords: Intracapsular neck of femur fracture; Treatment comparative.


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