Internal fixation of intracapsular femoral neck fractures in elderly patients: mortality and reoperation rate.

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.