The treatment of fractures of the femoral neck.
Fifty-four femoral neck fractures in young adults (20-50 years old; Group I) were compared with 397 fractures in the elderly population (older than 60 years of age; Group III). Patients in Group I were more frequently men and had often sustained vertical shear fractures in high-energy injuries. Treatment consisted mostly of open reduction and internal fixation (88%). There were no infections, pulmonary embolisms, or deaths. The rate of avascular necrosis was 10%; the rate of delayed union or nonunion, 17%; and the revision rate, 20%. Reoperation did not preclude an excellent final outcome. Patients in Group III were mostly women who fell at home and sustained an adduction fracture, which was most frequently (80%) treated with a cemented monopolar arthroplasty. Complications included pulmonary embolisms (3.5%), other cardiovascular complications (8%), and respiratory complications (7%). The death rate during hospitalization was 6.5%; for the first year after surgery it was 21%. These complications were not more frequent with either hemiarthroplasty or internal fixation. Local complications required revision of 17% of the cases treated with internal fixation and 1.4% of the patients treated with hemiarthroplasty. In the entire series, the deep infection rate without prophylactic antibiotics was 1.5%; with prophylactic systemic antibiotics it was 0.7%. The incidence of pulmonary embolism without thromboprophylaxis was 3.2%; with fixed-dose, subcutaneous heparin it was 1.1%. Of those treatments tested, open reduction and internal fixation with cancellous bone screws (for the younger patients) and hemiarthroplasty (for the elderly patients) yield the best short-to-midterm results. In addition, thromboprophylaxis with fixed-dose subcutaneous heparin and systemic antibiotic prophylaxis will continue to be used.
Department of Orthopaedic Surgery, University of Bern, Inselspital, Switzerland.
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Gerber
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Strehle
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Ganz
D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D005265:Femoral Neck Fractures / Q000145:classification / Q000601:surgery / Q000628:therapy*; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D016896:Treatment Outcome