title: Femoral neck fractures in patients receiving long-term dialysis.
abstract: The morbidity and mortality of 11 femoral neck fractures were analyzed to compare operative and conservative management of femoral neck fractures in dialysis patients. All fractures occurred in older men with severe cardiac, pulmonary, gastro-intestinal, and neurologic conditions and with advanced renal osteodystrophy. Six of the seven operated patients survived the surgery and achieved varying degrees of ambulation. Stability of the operated hip was excellent in each case. Post-operative complications included transient confusional state related to narcotics, pneumonia, decubitus ulcers, and severe hypoalbuminemia. All four patients who were managed conservatively died from complications of the fracture. Progressive deterioration was noted in each nonoperated patient, with confusion caused by narcotics and analgesics, pneumonia, hepatic coma, decubitus ulcers, severe depression, and severe hypoalbuminemia. Therefore, operative management was superior to conservative management for femoral neck fractures of patients receiving chronic dialysis with multiple medical problems and advanced renal osteodystrophy. Narcotics must be used with great caution, and efforts should be directed toward prevention of malnutrition and decubitus ulcers.
authors.affiliation: Department of Orthopaedics, Albuquerque Veterans Administration Medical Center, New Mexico 87108.
authors.forename: P C
authors.initials: PC
authors.lastname: Schaab
authors.forename: G
authors.initials: G
authors.lastname: Murphy
authors.forename: A H
authors.initials: AH
authors.lastname: Tzamaloukas
authors.forename: M B
authors.initials: MB
authors.lastname: Hays
authors.forename: T L
authors.initials: TL
authors.lastname: Merlin
authors.forename: B
authors.initials: B
authors.lastname: Eisenberg
authors.forename: P S
authors.initials: PS
authors.lastname: Avasthi
authors.forename: R V
authors.initials: RV
authors.lastname: Worrell
mesh_terms: D000368:Aged; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000150:complications* / Q000209:etiology; D005265:Femoral Neck Fractures / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D005594:Fracture Fixation, Intramedullary; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D006435:Renal Dialysis / Q000009:adverse effects*