Hip Pelvis.  2016 Mar;28(1):43-48. 10.5371/hp.2016.28.1.43.

Result of Internal Fixation for Stable Femoral Neck Fractures in Elderly Patients

• Min BW
• Lee KJ
• Bae KC
• Lee SW
• Lee SJ
• Choi JH

• KMID: 2161314
• DOI: http://doi.org/10.5371/hp.2016.28.1.43

Abstract

PURPOSE
This study was conducted to evaluate the results of internal fixation for stable femoral neck fractures occurring in patients over 65 years old.
MATERIALS AND METHODS
Between 2008 and 2014, we evaluated 25 patients over 65 years old with Garden type 1 and 2 femoral neck fractures that were treated with internal fixation after a minimum follow up of 1 year. There were 5 males and 20 females and the average age was 72.3 years (range, 65-84 years) at the time of surgery. Fracture site union, horizontal shortening and complications were evaluated as radiographic parameters and change of walking ability (as measured using Koval walking ability score) was investigated as a clinical parameter.
RESULTS
Union of fracture site was achieved in 24 out of the 25 cases (96.0%). The average length of horizontal shortening was 6.5 mm (range, 0.2-19.7 mm). At final follow up, 3 cases experienced complications: nonunion (n=1), avascular necrosis (n=1), and subtrochanteric fracture after minor trauma (n=1). Walking ability decreased an average of 1 step at the final follow up.
CONCLUSION
Internal fixation for stable femoral neck fractures occurring in patients over 65 years showed satisfactory union rates. However, care should be taken with this technique given the possibility of decreased walking ability resulting from horizontal shortening.

Keyword

Femur; Stable fracture; Internal fracture fixation

MeSH Terms

Aged*
Female
Femoral Neck Fractures*
Femur
Femur Neck*
Follow-Up Studies
Fracture Fixation, Internal
Humans
Male
Necrosis
Walking

Figure

• 

  Fig. 1 (A) Preoperative radiograph of 77 years old female shows stable femoral neck fracture (Garden type 1). (B) Radiograph taken 29 months after internal fixation with cannulated screws shows well united fracture site but decreased horizontal shortening more than 6.5 mm compared to opposite femur. The horizontal shortening was measured as the difference of length from medial border of femoral head to lateral border of greater trochanter between contralateral femur (b) and ipsilateral femur (a).

• 

  Fig. 2 (A) Preoperative radiograph of 67 years old male shows stable femoral neck fracture (Garden type 2). (B) Radiograph taken 36 months after internal fixation shows well united fracture site.

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  Fig. 3 (A) Preoperative radiograph of 84 year old female shows stable femoral neck fracture (Garden type 2). (B) In situ fixation with cannulated screws was done within 24 hours. (C) Radiograph taken 5 months after internal fixation shows nonunion of fracture site.

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