JOURNAL READING TREATMENT FAILURE IN STABLE FEMORAL NECK FRACTURES IN THE ELDERLY

Susan L. Stewart, MD, Daniel R. Cooperman, MD, Randall E. Marcus, MD

ORTHOPAEDIC JOURNAL CASE WESTERN RESERVE UNIVERSITY | VOL. 1 , NO. 1 | 2 0 0 4

Oleh Sarrah Kusuma Dewi NIM 072011101028

SMF BEDAH RSD dr. SOEBANDI FAKULTAS KEDOKTERAN UNIVERSITAS JEMBER 2011

ABSTRACT
orthopaedic surgeon can expect to treat octogenarian and nonagenarian patients

The younger patient

Femoral neck fractures (non-displaced, minimally displaced, and valgus impacted)

Good prognosis when managed by internal fixation with multiple screws

The elderly patient

To evaluate

ABSTRACT

Eight patients (32%) from 25 had unsatisfactory results and were considered treatment failures:

Five patients failed to heal their fractures three patientsfractures healed but developed late avascular necrosis.

Conclution: the treatment with internal fixation in the elderly population for non-displaced, minimally displaced, or valgus impacted femoral neck fractures may fail in approximately one-third of patients.

INTRODUCTION

The incidence of hip fractures increases exponentially with age will allow the orthopaedic surgeon to give these elderly patients the best care

Approximately half of all hip fractures located in the femoral neck (non-displaced or valgus impacted) they are typically managed by internal fixation in situ utilizing multiple screws.

INTRODUCTION

We examined the success of fracture treatment utilizing multiple screw fixation in nondisplaced, minimally displaced, and valgus impacted femoral neck fractures in octogenarian and nonagenarian patients.
A treatment failure was defined as a patient who developed avascular necrosis or non-union at risk for the morbidity of dysfunction or a second operation, like hemiarthroplasty.

MATERIALS AND METHODS

25 patients had sufficient clinical data and complete radiographic information to allow us to retrospectively evaluate the course of the fracture to a stage of healing or to a stage of treatment failure because of non-union or avascular necrosis.
Using Fishers exact test analyzed the effect of gender, type of fracture, and postoperative complications with respect to non-union or AVN. compared our rate of treatment failure with failure rates noted by previous authors.

MATERIALS AND METHODS

19 female 6 male

Gender

Preoperative radiographs

17 valgus impacted 5 nondisplaced fractures 3 minimally displaced fractures (displacement of a few millimeters or less).

MATERIALS AND METHODS

24 patients suffered from multiple preexisting medical problems 4 patients ASA IV; 13 ASA III; 8 ASA II.

Preexisting Medical Problems

Fracture Management

The average time between fracture and surgery was 2.7 days (range, 1-4 days) The average hospital stay was 7.68 days (range, 3-10 days) 2-4 cannulated screws were utilized for fracture fixation

MATERIALS AND METHODS

The surgical procedure performed utilizing the fracture table with fluoroscopic C-arm imaging, consisted of placing percutaneous, parallel, cannulated screws into the center of the femoral head to a depth approximately 5 to 10 mm from the articular surface. All fractures were in adequate alignment and no apparent reduction or change in alignment was noted from preoperative to postoperative radiographs. Postoperatively, patients were mobilized out of bed with weightbearing as tolerated within 24 hours of the surgical procedure.

RESULTS

Complications

8 patients postoperative complications wound hematoma, transient ischemic attack, pulmonary embolism, urinary tract infection, congestive heart failure; decline in mental status postoperatively

Mortality

32% (8 patients) expired within 2 years of their surgery. 2 patients died at 5 months following fracture fixation, 2 at 7 months, and 4 died between 13 and 24 months following fracture fixation. The remaining patients survived at least 2 years following their surgery

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