Comparison of three different procedures in the treatment of senile femoral neck fracture

Abstract

Objective To compare internal fixation and arthroplasty in curative effects for the femoral neck fractures in the aged population. Methods All the 182 old patients with femoral neck fracture who had been treated from January 1999 to August 2007 in our department were reviewed. Of them, 42 cases received internal fixation (Group A), 64 femoral head arthroplasty (Group B) and 76 total hip joint replacement (Group C) . The 3 groups were similar in age, fracture classification and preoperative health condition. Their average follow-up was 38 (25 to 65) months. Comparisons were made between the 3 groups in hospitalization, operating duration, intraoperative bleeding, ambulation time, postoperative complications, secondary surgery, and functional recovery. Results Group A had less operating duration and blood loss, a healing rate of 90.5% (38/42), a rate of avascular femoral head necrosis of 23.8% (10/42), and a re-operation rate of 26. 2% (11/42). In Groups B and C, the re-operation rate was 7.8% (5 cases) and 5.3% (4 cases) respectively. The good-to-excellent rates of functional recovery were 85.9% (55/64), 89.5% (68/76) and 61.9% (26/42) respectively in Groups B, C, and A. In operating duration, blood loss, ambulation time, complications, secondary surgery and functional recovery, there was a significant difference (P 0.05). Conclusions In treatment of femoral neck fracture of Garden Ⅰ and Ⅱ in patients older than 60 years, internal fixation may be the first choice, and arthroplasty may be suitable for patients older than 65 years or those with fractures of Garden Ⅲ and Ⅳ. Key words: Femoral fractures; Fracture fixation, internal; Arthroplasty, replacement, hip; Aged