Femoral neck fractures in the geriatric population: the influence of perioperative health upon the selection of surgical treatment.
The use of a primary prosthetic replacement such as an Austin-Moore hemi-arthroplasty in patients sustaining fractures of the femoral neck has been associated with increased post-operative medical morbidity and mortality. A retrospective review was performed using the medical records of patients greater than 59 years of age who sustained femoral neck fractures and were treated with either internal fixation or primary hemi-arthroplastic replacement at Loyola University Medical Center between 1969 and 1979. Peri-operative data were reviewed and evaluated using computer-aided statistical analysis. Comparing the two forms of surgical treatment, statistically significant factors associated with primary hemi-arthroplastic replacement included: pre-injury nursing home residence, pre-injury ambulation requiring assistance, age greater than 79 years, slight elevation in serum creatinine values, abnormal electrocardiograms in patients over 77 years of age, time from injury to surgery of four or more days, and the use of spinal anesthesia (P less than 0.05). Factors associated with internal fixation were: patient age of 79 years or less, independent ambulation, non-nursing home residence, normal lab values, normal EKGs, less than four days from injury to surgery, and the use of general anesthesia. Within the limits imposed by a retrospective review in this specific patient population, there appears to be a tendency for older, less healthy patients to have been treated with primary hemi-arthroplasty. Possibly the previously reported increased post-operative medical morbidity and mortality associated with this procedure, as compared with internal fixation, may be a result of biased patient selection, and not a fault of the procedure.
D000367:Age Factors; D000368:Aged; D000775:Anesthesia, Spinal; D003404:Creatinine / Q000097:blood; D004562:Electrocardiography; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000009:adverse effects; D006262:Health; D006304:Health Status; D006622:Hip Prosthesis / Q000009:adverse effects; D006801:Humans; D008124:Locomotion; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D012189:Retrospective Studies
D003404:Creatinine