Internal fixation of intracapsular femoral neck fractures in elderly patients: mortality and reoperation rate
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ORIGINAL ARTICLE
Internal fixation of intracapsular femoral neck fractures in elderly patients: mortality and reoperation rate Marco Bigoni1,2 · Marco Turati1,2,3 · Giulio Leone1,2 · Agostino Dario Caminita1,2 · Fabio D’Angelo4 · Daniele Munegato1,2 · Giovanni Zatti1,2 Received: 29 April 2019 / Accepted: 31 May 2019 © Springer Nature Switzerland AG 2019
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. Keywords Elderly · Screw fixation · Hip fractures · Osteoporosis
Introduction A significant increase in the prevalence and in the agespecific incidence rates of hip fractures has been reported worldwide [1–3]. Most of the patients with hip fracture are * Giulio Leone [email protected] 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
Division of Orthopaedics and Traumatology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varèse, Italy
elderly people and many of those already suffering from other major comorbidities [4]. Indeed high rates of morbidity and mortality are reported following this type of fractures [1]. Approximately, half of the previously independent elderly patients become partly dependent and ultimately a third totally dependent. The 1-year-mortality after hip fracture is reported varying from 13 to 36% with a mean value of 25% [5–8]; part of this excess mortali
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