Effect of improved posterolateral minimally invasive approach combined with modular femoral head prosthesis in treatment of femoral neck fractures in elderly patients

Abstract

Objective To compare the clinical effects of improved posterolateral minimally invasive approach and traditional posterolateral approach combined with modular femoral head prosthesis in the treatment of femoral neck fractures in the elderly. Methods The study involved 70 patients with femo- ral neck fractures （ 26 males and 44 females ; at age range of 67-95 years, mean 78.3 years） treated from October 2008 to June 2010. There were 62 patients with fresh femoral neck fractures and eight with old femoral neck fractures （2-4 months post-injury）, all of whom were type Ⅲor Ⅳ fractures according to the Garden＇ s classification. All surgeries were completed by the same operation group. The improved posterolateral minimally invasive approach group involved 32 patients including 12 males and 20 females and the traditional posterolateral approach group involved 38 patients including 14 males and 24 females. The two groups were compared in aspects of incision size, operative time, perioperative complications, prosthesis stability and hip functional recovery. Results All patients were followed up for an average of 16 weeks （range, 12-18 weeks）. The differences between the two groups were significant regarding the incision length, perioperative blood loss, and blood product transfusio amount （ P 〈 0.01 ） , but insignifi- cant in operative time （ P 〉 0.05 ）. All patients were able to take weight-bearing walk six weeks postoperatively. The two groups showed significant difference in the hip joint function by Charnley＇s criteria six weeks postoperatively （ P 〈 O. 05 ）, but insignificant difference in the hip joint function by Harris＇ s crite- ria at the last follow-up （P 〈 0.05 ）. Conclusion The modified posterolateral minimally invasive ap- proach combined with modular femoral head prosthesis is a satisfactory method in treatment of femoral neck fractures in senile patients, for it can result in less intra-operative soft tissue damage and blood loss,as well as shorter rehabilitation time. Key words: Femoral neck fractures ; Surgical procedure, minimally invasive; Arthoplasty,replacement, hip; Modular femoral head