Assessment of time factor in managing femoral neck fractures by internal fixation in patients above 55 years of age

Abstract

Background Intracapsular hip fractures account for approximately half of all hip fractures. Present treatment of an intracapsular fracture entails either replacement arthroplasty or preservation of the femoral head. In old age patients, the decision between fixation and arthroplasty becomes an issue: Although fixation is a biological solution for this fracture treatment, it has a high nonunion rate with a long postoperative recumbency period and its known complications; in contrast, arthroplasty has its advantage in early mobilization of the patient but has its well-known complications, starting with infection and ending with loosening and the need for revisions. Evidence from the literature on the effect of timing of fixation on outcomes after femoral neck fractures is conflicting. The purpose of this study was to analyze the effect of timing of surgery on the incidence of nonunion and avascular necrosis (AVN) after internal fixation of femoral neck fractures in patients above the age of 55 years. Patients and methods This study included 30 patients (13 men and 17 women) between 56–77 years of age (average 65.1 years) with femoral neck fractures who were treated by closed reduction and internal fixation and were followed up for a minimum of period of 2 years. Nineteen patients (63.33%) had displaced fractures. The average time lag between injury and surgery was 37.5 h (6–144). The patients were divided into two groups: 12 patients (40%) were treated within 12 h after injury (early fixation group) and 18 (60%) were treated more than 12 h after injury (late fixation group). All patients were treated by closed reduction and multiple screw fixation. Results The average age of the patients in the early fixation group (12 patients) was 61.9 years and that of patients in the late fixation group (18 patients) was 67.7 years. There were seven women in the early fixation group and 10 in the late fixation group. There were eight cases of displaced fractures (66.67%) in the early fixation group and 11 cases (61.1%) of the same in the late fixation group. The average time lag between injury and fixation was 10.5 h in the early fixation group and 54.78 h in the late fixation group. All fractures united within an average period of 86.8 days (range 60–128). The final results were satisfactory in 22 hips (73.33%) and unsatisfactory in eight hips (26.67%). No statistically significant difference was found in the duration of fracture union and AVN with regard to sex distribution and mechanism of injury. Variables affecting the final results of treatment were: the time factor, age at surgery and type of fracture. Conclusion Closed reduction and internal fixation is a valid contribution to the treatment of femoral neck fractures in patients above 55 years of age (56–65). The rate of nonunion and AVN was affected by a delay of more than 12 h before fixation for femoral neck fractures in this age group. The incidence of failure was significantly higher in patients aged 65 years or above and in cases of displaced fractures.