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. 2007 Oct;31(5):677-82.
doi: 10.1007/s00264-006-0243-3. Epub 2006 Oct 11.

Surgical treatment of undisplaced femoral neck fractures in the elderly

Lee Yih-Shiunn  1 , Huang Chien-Rae, Liao Wen-Yun
Affiliations

Surgical treatment of undisplaced femoral neck fractures in the elderly

Lee Yih-Shiunn et al. Int Orthop. 2007 Oct.

Abstract
in English, French

The study was a retrospective evaluation and comparison. Eighty-four elderly patients (> 60 years) with undisplaced intracapsular femoral neck fractures were treated with osteosynthesis with either dynamic hip screws (DHS) or multiple cannulated screws (MCS). The Singh index was used to evaluate bone quality. All patients were followed up retrospectively for at least 12 months. The clinical results were compared between the DHS and MCS groups. Both groups were similar in respect of injury mechanisms, mean Singh index, injury-surgery interval, gender and age (all p values > or = 0.29). The MCS group had significantly smaller wound incisions, less haemoglobin level drops, lower blood transfusion rates and shorter hospital stays than the DHS group (all p values < or = 0.008). However, the DHS group had a higher rate of overall success when compared to the MCS group (97.5% versus 84.1%, p=0.04). In conclusion, although DHS fixation requires a larger skin incision and more soft tissue dissection, its use in elderly patients with osteoporosis is recommended due to simple, efficacy and high overall success rate.

Etude rétrospective, avec un suivi d’au moins 12 mois, de 84 patients âgés de plus de 60 ans avec une fracture intracapsulaire sans déplacement du col fémoral, traités par ostéosynthèse avec soit une vis-plaque dynamique (DHS) soit plusieurs vis canulées (MCS). L’index de Singh était utilisé pour évaluer la qualité osseuse. Les 2 groupes étaient similaires par le mécanisme traumatique, l’index de Singh, le délai de la chirurgie, le genre et l’âge. Le groupe MCS avait une plus courte incision, une moindre chute du niveau d’hémoglobine, un plus faible taux de transfusion et un plus court séjour hospitalier que le groupe DHS. Cependant le groupe DHS avait un meilleur taux global de succès que le groupe MCS ( 97,5% versus 84,1%, p=0,04). En conclusion, bien que la fixation par vis-plaque dynamique demande une plus grande dissection des parties molles, son utilisation chez les patients âgés et ostéoporotiques est recommandé en raison de son taux global de succès.

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Figures

Fig. 1
Fig. 1
A 78-year-old male patient with femoral neck fracture was treated with dynamic hip screw. (a) Preoperative radiograph showed an undisplaced intracapsular femoral neck fracture. (b) Radiograph at the final follow-up (postoperatively 30 months) showed solid union without any evidence of mechanical failure
Fig. 2
Fig. 2
A 75-year-old female patient with chronic renal insufficiency had an undisplaced femoral neck fracture treated with three cannulated screws. (a) Preoperative radiograph showed undisplaced femoral neck fracture (arrow). (b) Radiograph at postoperatively 4 months showed severe avascular necrosis of femoral head
See this image and copyright information in PMC

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