Factors Influencing Treatment of Proximal Femoral Fractures.

Abstract

Orthopaedics and traumatology departments are dominated by patients with proximal femoral fractures, who represent 20-30% of all patients treated there. The aim of this study was identification and evaluation of factors influencing treatment of proximal femoral fractures. Between 2008 and 2015, we treated 424 femoral neck fractures and 442 trochanteric fractures in patients over 40 y/o. The impact of fracture location (femoral neck/trochanteric), character (non-displaced/displaced) and the patient's general condition (metrical/biological age, health condition) on qualification and treatment used (fixations/hip pro-sthesis/non-operative) was analyzed. The results show a significant impact of factors such as type of fracture and general health condition on treatment method selection (mainly in femoral neck fractures). The distinction between non-displaced and displaced fractures is significant in preoperative qualification. For displaced femoral neck fractures, total hip replacement (non-cemented) was performed in patients between 55 and 65 y/o, while total hip replacement (cemented) and hemiarthroplasty (bipolar/Austin Moore's) in patients between 75 and 90 y/o. In lateral fractures of the femoral neck, mostly total hip replacement and occasionally proximal femoral nail fixation was performed. The importance of qualification factors was much lower in preoperative qualification of trochanteric fractures, where internal fixation remains the primary method of treatment and total hip replacement was only used in patients with co-existing coxarthrosis. 1. The biggest impact on selection of femoral neck fractures treatment method was exerted by the degree of displacement of bone fragments, age and the patient's pre-injury walking status. 2. Besides general condition, the presence of coxarthrosis was the most important factor influencing trochanteric fracture treatment method.