Acta Medica Medianae (Sep 2010)
METHOD OF CHOISE IN THE TREATMENT OF FEMORAL NECK FRACTURES IN SUBJECTS AGED OVER 65
Abstract
Of all femoral bone injuries, femoral neck fractures cause the largest number of surgical, medical and economic problems.The research aimed to determine, within the tested sample, the benefits of the treatment of femoral neck fractures with primary femoral prosthesis.The study involved 102 patients. The following parameteres were monitored: radiographic processing, BMD, times of sustaining the fracture, admission and surgical treatment, preoperative and postoperative complications, etc.The average age of patients was 86.2 years. FNFs (femoral neck fractures) were classified using Garden’s classification: Type I accounted for 0% of femoral neck fractures, Type II for 5.88%, Type III for 50.98% and Type IV for 43.14%. The time interval between injury and surgery amounted to 3.9 days and chronic illnesses were reported in 50% of the patients. Fractures were treated with internal fixation: 22.54% with Müller plate, 2.94% with screws; and with endoprostheses: Austin-Moore partial endoprosthesis was used in 50.98% of the patients, cemented total endoprosthesis in 4.9%, and noncemented total prosthesis in 14.7%. General inhalation anaesthesia was used in 37.25% and spinal anaesthesia in 64.75% of the patients. 31.37% of the patients experienced complications. There were significant statistical differences in the time of verticalisation and full weight-bearing between the patients treated with endoprosthesis and those treated with internal fixation.In less physically active elderly patients secondary surgeries can be avoided byperforming primary arthroplasty. With displaced fractures there is a high risk of femoral head necrosis and pseudoarthrosis. In patients under the age of 65 who can endure a secondary operation in case of failure, the treatment of choice is internal fixation.Patients over the age of 65 need to be treated with primary arthroplasty in order to avoid secondary operations.
