Marco Bigoni1,2, Marco Turati1,2,3, Giulio Leone4,5, Agostino Dario Caminita1,2, Fabio D'Angelo6, Daniele Munegato1,2, Giovanni Zatti1,2. 1. Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900, Monza, Italy. 2. Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy. 3. Department of Paediatric Orthopedic Surgery, Hopital Couple Enfants, Grenoble Alpes University, Grenoble, France. 4. Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900, Monza, Italy. giulio.leone.bo@gmail.com. 5. Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy. giulio.leone.bo@gmail.com. 6. Division of Orthopaedics and Traumatology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varèse, Italy.
Abstract
BACKGROUND: A significant increase in the prevalence of intracapsular femoral neck fractures in the elderly population was reported but the best treatment is still debated. AIM: To evaluate the mortality rate and the reoperation rate of stable neck fractures treated with cannulated screw fixation in elderly patients. METHODS: This was a retrospective study of patients older than 60 years with a Garden I or II femoral neck fractures treated with cannulated screw fixation without capsulotomy. A total of 244 patients (246 hips) who underwent surgery between 2008 and 2018 were included. The average age at the time of surgery was 80 years (range 60-99 years). The mean ASA score was 2.64 (range 1-4). Mortality rate, complications, reoperation rate, the time elapsed between surgeries were recorded. RESULTS: The mortality rate was 50.0%. There were 16 mortalities (6.6%) in the first-month follow-up. We observed higher mortality rates in ASA 4 (80.8%). In 22 patients (8.9%), complications after surgery were observed, and in 11 patients (4.5%) underwent conversion surgery to hemiarthroplasty at a mean of 14.6 months (range 2-48 months) after the femoral screw fixation. Two patients were treated with hardware removal and Gamma Nail for a peri-implant subtrochanteric femur fracture. INTERPRETATION: Cannulated screw fixation should be considered a valid option in intraarticular femoral Garden I-II fractures in elderly patients. LEVEL OF EVIDENCE: Level IV, therapeutic study.
BACKGROUND: A significant increase in the prevalence of intracapsular femoral neck fractures in the elderly population was reported but the best treatment is still debated. AIM: To evaluate the mortality rate and the reoperation rate of stable neck fractures treated with cannulated screw fixation in elderly patients. METHODS: This was a retrospective study of patients older than 60 years with a Garden I or II femoral neck fractures treated with cannulated screw fixation without capsulotomy. A total of 244 patients (246 hips) who underwent surgery between 2008 and 2018 were included. The average age at the time of surgery was 80 years (range 60-99 years). The mean ASA score was 2.64 (range 1-4). Mortality rate, complications, reoperation rate, the time elapsed between surgeries were recorded. RESULTS: The mortality rate was 50.0%. There were 16 mortalities (6.6%) in the first-month follow-up. We observed higher mortality rates in ASA 4 (80.8%). In 22 patients (8.9%), complications after surgery were observed, and in 11 patients (4.5%) underwent conversion surgery to hemiarthroplasty at a mean of 14.6 months (range 2-48 months) after the femoral screw fixation. Two patients were treated with hardware removal and Gamma Nail for a peri-implant subtrochanteric femur fracture. INTERPRETATION: Cannulated screw fixation should be considered a valid option in intraarticular femoral Garden I-II fractures in elderly patients. LEVEL OF EVIDENCE: Level IV, therapeutic study.
Entities:
Keywords:
Elderly; Hip fractures; Osteoporosis; Screw fixation