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Erschienen in: European Journal of Trauma and Emergency Surgery 2/2016

18.04.2015 | Original Article

Clinical results of treatment of garden type 1 and 2 femoral neck fractures in patients over 70-year old

verfasst von: S. K. Han, H. S. Song, R. Kim, S. H. Kang

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 2/2016

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Abstract

Introduction

We retrospectively analyzed the clinical results of treatment of impacted or undisplaced femoral neck fractures (Garden types 1 and 2) by osteosynthesis in elderly patients >70-year old.

Materials and methods

We retrospectively reviewed the radiological results of 52 patients who were followed up for at least 6 months from April 2002 to December 2008. The average age of the patients was 77.6 years (range 70–97 years), and 38 patients were females. The mean follow-up period was 11.7 months (range 6–19 months). Thirteen cases were Garden type 1 fractures, and 39 were Garden type 2 fractures. We assessed the relationships between the occurrence of complications and age, sex, Garden stage, bone mineral density (BMD), history of contralateral hip fracture, and any additional hip injury.

Results

Major complications occurred in 18 cases (34.6 %), including nonunion (8 cases), osteonecrosis (6 cases), stress fracture of the subtrochanter (2 cases), excessive pull-out of a screw (1 case), and deep infection (1 case). The development of complications was associated with Garden stage 2, BMD, and additional hip injury. However, other factors were not associated with complications. Reoperations were performed in 16 cases (30.1 %), and 2 of the patients died during follow-up.

Conclusion

A relatively high rate of complications or reoperations developed after treatment of Garden 2 femoral neck fractures in senile patients >70 years of age with osteoporosis. Although internal fixation has been recommended in the literature for undisplaced femoral neck fractures, primary arthroplasty may be a better option for treatment of Garden type 2 fractures in elderly patients.
Literatur
1.
Zurück zum Zitat Bhandari M, Devereaux PJ, Tornetta P 3rd, et al. Operative management of displaced femoral neck fractures in elderly patients. An international survey. J Bone Jt Surg Am. 2005;87:2122–30.CrossRef Bhandari M, Devereaux PJ, Tornetta P 3rd, et al. Operative management of displaced femoral neck fractures in elderly patients. An international survey. J Bone Jt Surg Am. 2005;87:2122–30.CrossRef
2.
Zurück zum Zitat Shah AK, Eissler J, Radomisli T. Algorithms for the treatment of femoral neck fractures. Clin Orthop Relat Res. 2002;399:28–34.CrossRefPubMed Shah AK, Eissler J, Radomisli T. Algorithms for the treatment of femoral neck fractures. Clin Orthop Relat Res. 2002;399:28–34.CrossRefPubMed
3.
Zurück zum Zitat Sendtner E, Renkawitz T, Kramny P, Wenzl M, Grifka J. Fractured neck of femur—internal fixation versus arthroplasty. Dtsch Arztebl Int. 2010;107(23):401–7.PubMedPubMedCentral Sendtner E, Renkawitz T, Kramny P, Wenzl M, Grifka J. Fractured neck of femur—internal fixation versus arthroplasty. Dtsch Arztebl Int. 2010;107(23):401–7.PubMedPubMedCentral
4.
Zurück zum Zitat Waaler Bjørnelv GM, Frihagen F, Madsen JE, Nordsletten L, Aas E. Hemiarthroplasty compared to internal fixation with percutaneous cannlated screws as treatment of displaced femoral neck fractures in the elderly: cost-utility analysis performed alongside a randomized, controlled trial. Osteoporos Int. 2012;23:1711–9.CrossRefPubMed Waaler Bjørnelv GM, Frihagen F, Madsen JE, Nordsletten L, Aas E. Hemiarthroplasty compared to internal fixation with percutaneous cannlated screws as treatment of displaced femoral neck fractures in the elderly: cost-utility analysis performed alongside a randomized, controlled trial. Osteoporos Int. 2012;23:1711–9.CrossRefPubMed
5.
Zurück zum Zitat Kos N, Burger H, Vidmar G. Mobility and functional outcomes after femoral neck fracture surgery in elderly patients: a comparison between hemiarthroplasty and internal fixation. Disabil Rehabil. 2011;33:2264–71.CrossRefPubMed Kos N, Burger H, Vidmar G. Mobility and functional outcomes after femoral neck fracture surgery in elderly patients: a comparison between hemiarthroplasty and internal fixation. Disabil Rehabil. 2011;33:2264–71.CrossRefPubMed
6.
Zurück zum Zitat Gao H, Liu Z, Xing D, Gong M. Which is the best alternative for displaced femoral neck fractures in the elderly?: a meta-analysis. Clin Orthop Relat Res. 2012;470:1782–91.CrossRefPubMedPubMedCentral Gao H, Liu Z, Xing D, Gong M. Which is the best alternative for displaced femoral neck fractures in the elderly?: a meta-analysis. Clin Orthop Relat Res. 2012;470:1782–91.CrossRefPubMedPubMedCentral
7.
Zurück zum Zitat Rogmark C, Johnell O. Primary arthroplasty is better than internal fixation of displaced femoral neck fractures: a meta-analysis of 14 randomized studies with 2289 patients. Acta Orthop. 2006;77:359–67.CrossRefPubMed Rogmark C, Johnell O. Primary arthroplasty is better than internal fixation of displaced femoral neck fractures: a meta-analysis of 14 randomized studies with 2289 patients. Acta Orthop. 2006;77:359–67.CrossRefPubMed
8.
Zurück zum Zitat Frihagen F, Waaler GM, Madsen JE, Nordsletten L, Aspaas S, Aas E. The cost of hemiarthroplasty compared to that of internal fixation for femoral neck fractures. Acta Orthop. 2010;81:446–52.CrossRefPubMedPubMedCentral Frihagen F, Waaler GM, Madsen JE, Nordsletten L, Aspaas S, Aas E. The cost of hemiarthroplasty compared to that of internal fixation for femoral neck fractures. Acta Orthop. 2010;81:446–52.CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Jain NB, Losina E, Ward DM, Harris MB, Katz JN. Trends in surgical management of femoral neck fractures in the United States. Clin Orthop Relat Res. 2008;466:3116–22.CrossRefPubMedPubMedCentral Jain NB, Losina E, Ward DM, Harris MB, Katz JN. Trends in surgical management of femoral neck fractures in the United States. Clin Orthop Relat Res. 2008;466:3116–22.CrossRefPubMedPubMedCentral
10.
Zurück zum Zitat Parker MJ, White A, Boyle A. Fixation versus hemiarthroplasty for undisplaced intracapsular hip fractures. Injury. 2008;39:791–5.CrossRefPubMed Parker MJ, White A, Boyle A. Fixation versus hemiarthroplasty for undisplaced intracapsular hip fractures. Injury. 2008;39:791–5.CrossRefPubMed
11.
Zurück zum Zitat Conn KS, Parker MJP. Undisplaced intracapsular hip fractures: results of internal fixation in 375 patients. Clin Orthop Relat Res. 2004;421:249–54.CrossRefPubMed Conn KS, Parker MJP. Undisplaced intracapsular hip fractures: results of internal fixation in 375 patients. Clin Orthop Relat Res. 2004;421:249–54.CrossRefPubMed
12.
Zurück zum Zitat Kain MS, Marcantonio AJ, Iorio R. Revision surgery occurs frequently after percutaneous fixation of stable femoral neck fractures in elderly patients. Clin Orthop Relat Res. 2014;472(12):4010–4.CrossRefPubMedPubMedCentral Kain MS, Marcantonio AJ, Iorio R. Revision surgery occurs frequently after percutaneous fixation of stable femoral neck fractures in elderly patients. Clin Orthop Relat Res. 2014;472(12):4010–4.CrossRefPubMedPubMedCentral
13.
Zurück zum Zitat Rogmark C, Flensburg L, Fredin H. Undisplaced femoral neck fractures—no problems? A consecutive study of 224 patients treated with internal fixation. Injury. 2009;40:274–6.CrossRefPubMed Rogmark C, Flensburg L, Fredin H. Undisplaced femoral neck fractures—no problems? A consecutive study of 224 patients treated with internal fixation. Injury. 2009;40:274–6.CrossRefPubMed
14.
Zurück zum Zitat Gjertsen JE, Fevang JM, Matre K, Vinje T, Engesaeter LB. Clinical outcome after undisplaced femoral neck fractures. Acta Orthop. 2011;82:268–74.CrossRefPubMedPubMedCentral Gjertsen JE, Fevang JM, Matre K, Vinje T, Engesaeter LB. Clinical outcome after undisplaced femoral neck fractures. Acta Orthop. 2011;82:268–74.CrossRefPubMedPubMedCentral
15.
Zurück zum Zitat Handoll HH, Parker MJ. Conservative versus operative treatment for hip fractures in adults. Cochrane Database Syst Rev. 2008;16(3):CD000337. Handoll HH, Parker MJ. Conservative versus operative treatment for hip fractures in adults. Cochrane Database Syst Rev. 2008;16(3):CD000337.
16.
17.
Zurück zum Zitat Wu CC, Chen WJ. Minimally displaced intra-capsular femoral neck fractures in the elderly-comparison of multiple threaded pins and sliding compression screws surgical techniques. J Orthop Surg (Hong Kong). 2003;11(2):129–36. Wu CC, Chen WJ. Minimally displaced intra-capsular femoral neck fractures in the elderly-comparison of multiple threaded pins and sliding compression screws surgical techniques. J Orthop Surg (Hong Kong). 2003;11(2):129–36.
18.
Zurück zum Zitat Rupprecht M, Grossterlinden L, Ruecker AH, et al. A comparative biomechanical analysis of fixation devices for unstable femoral neck fractures: the Intertan versus cannulated screws or a dynamic hip screw. J Trauma. 2011;71(3):625–34.CrossRefPubMed Rupprecht M, Grossterlinden L, Ruecker AH, et al. A comparative biomechanical analysis of fixation devices for unstable femoral neck fractures: the Intertan versus cannulated screws or a dynamic hip screw. J Trauma. 2011;71(3):625–34.CrossRefPubMed
19.
Zurück zum Zitat Lee YS, Chen SH, Tsuang YH, Huang HL, Lo TY, Huang CR. Internal fixation of undisplaced femoral neck fractures in the elderly: a retrospective comparison of fixation methods. J Trauma. 2008;64(1):155–62.CrossRefPubMed Lee YS, Chen SH, Tsuang YH, Huang HL, Lo TY, Huang CR. Internal fixation of undisplaced femoral neck fractures in the elderly: a retrospective comparison of fixation methods. J Trauma. 2008;64(1):155–62.CrossRefPubMed
20.
Zurück zum Zitat Galla M, Lobenhoffer P. The minimally-invasive screw osteosynthesis of the medial femoral neck fracture in the very old. A prospective clinical study. Unfallchirurg. 2004;107(5):381–7.CrossRefPubMed Galla M, Lobenhoffer P. The minimally-invasive screw osteosynthesis of the medial femoral neck fracture in the very old. A prospective clinical study. Unfallchirurg. 2004;107(5):381–7.CrossRefPubMed
21.
Zurück zum Zitat Parker MJ, Raghavan R, Gurusamy K. Incidence of fracture-healing complications after femoral neck fractures. Clin Orthop Relat Res. 2007;458:175–9.PubMed Parker MJ, Raghavan R, Gurusamy K. Incidence of fracture-healing complications after femoral neck fractures. Clin Orthop Relat Res. 2007;458:175–9.PubMed
22.
Zurück zum Zitat Hui AC, Anderson GH, Choudhry R, Boyle J, Gregg PJ. Internal fixation or hemiarthroplasty for undisplaced fractures of the femoral neck in octogenarians. J Bone Jt Surg Br. 1994;76:891–4. Hui AC, Anderson GH, Choudhry R, Boyle J, Gregg PJ. Internal fixation or hemiarthroplasty for undisplaced fractures of the femoral neck in octogenarians. J Bone Jt Surg Br. 1994;76:891–4.
23.
Zurück zum Zitat Shimizu T, Miyamoto K, Masuda K, et al. The clinical significance of impaction at the femoral neck fracture site in the elderly. Arch Orthop Trauma Surg. 2007;127:515–21.CrossRefPubMed Shimizu T, Miyamoto K, Masuda K, et al. The clinical significance of impaction at the femoral neck fracture site in the elderly. Arch Orthop Trauma Surg. 2007;127:515–21.CrossRefPubMed
24.
Zurück zum Zitat Chen WC, Yu SW, Tseng IC, Su JY, Tu YK, Chen WJ. Treatment of undisplaced femoral neck fractures in the elderly. J Trauma. 2005;58:1035–9.CrossRefPubMed Chen WC, Yu SW, Tseng IC, Su JY, Tu YK, Chen WJ. Treatment of undisplaced femoral neck fractures in the elderly. J Trauma. 2005;58:1035–9.CrossRefPubMed
25.
Zurück zum Zitat Bjørgul K, Reikerås O. Outcome of undisplaced and moderately displaced femoral neck fractures. Acta Orthop. 2007;78:498–504.CrossRefPubMed Bjørgul K, Reikerås O. Outcome of undisplaced and moderately displaced femoral neck fractures. Acta Orthop. 2007;78:498–504.CrossRefPubMed
26.
Zurück zum Zitat Jarolem KL, Koval KJ, Zucjerman JD, Aharonoff G. A comparison of modified Knowles pins and cannulated screws for the treatment of nondisplaced or impacted femoral neck fractures. Bull Hosp Jt Dis. 1993;53:11–4.PubMed Jarolem KL, Koval KJ, Zucjerman JD, Aharonoff G. A comparison of modified Knowles pins and cannulated screws for the treatment of nondisplaced or impacted femoral neck fractures. Bull Hosp Jt Dis. 1993;53:11–4.PubMed
27.
Zurück zum Zitat Palm H, Krasheninnikoff M, Lemser T, et al. A new algorithm for hip fracture surgery. Reoperation rate reduced from 18 to 12 % in 2000 consecutive patients followed for 1 year. Acta Orthop. 2012;83:26–30.CrossRefPubMedPubMedCentral Palm H, Krasheninnikoff M, Lemser T, et al. A new algorithm for hip fracture surgery. Reoperation rate reduced from 18 to 12 % in 2000 consecutive patients followed for 1 year. Acta Orthop. 2012;83:26–30.CrossRefPubMedPubMedCentral
28.
Zurück zum Zitat Sjostedt A, Zetterberg C, Hasson T, Hult E, Ekstrom L. Bone mineral content and fixation strength of femoral neck fractures. A cadaver study. Acta Orthop Scand. 1994;65:161–5.CrossRefPubMed Sjostedt A, Zetterberg C, Hasson T, Hult E, Ekstrom L. Bone mineral content and fixation strength of femoral neck fractures. A cadaver study. Acta Orthop Scand. 1994;65:161–5.CrossRefPubMed
29.
Zurück zum Zitat Heetveld MJ, Raaymakers EL, van Eck-Smit BL, Van Walsum AD, Luitse JS. Internal fixation for displaced fractures of the femoral neck. Does bone density affect clinical outcome? J Bone Jt Surg Br. 2005;87:367–73.CrossRef Heetveld MJ, Raaymakers EL, van Eck-Smit BL, Van Walsum AD, Luitse JS. Internal fixation for displaced fractures of the femoral neck. Does bone density affect clinical outcome? J Bone Jt Surg Br. 2005;87:367–73.CrossRef
30.
Zurück zum Zitat Jansen H, Frey SP, Meffert RH. Subtrochanteric fracture: a rare but severe complication after screw fixation of femoral neck fracture in the elderly. Acta Orthop Belg. 2010;76:778–84.PubMed Jansen H, Frey SP, Meffert RH. Subtrochanteric fracture: a rare but severe complication after screw fixation of femoral neck fracture in the elderly. Acta Orthop Belg. 2010;76:778–84.PubMed
Metadaten
Titel
Clinical results of treatment of garden type 1 and 2 femoral neck fractures in patients over 70-year old
verfasst von
S. K. Han
H. S. Song
R. Kim
S. H. Kang
Publikationsdatum
18.04.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Trauma and Emergency Surgery / Ausgabe 2/2016
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-015-0528-6

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