Comparison of different ways of repairing fresh femoral neck fracture in the elderly

Li Gui-chun; Wang Wen-ji

doi:10.3969/j.issn.2095-4344.2015.09.014

Abstract：BACKGROUND:The internal fixation and total hip replacement are two main methods for the treatment of fresh femoral neck fracture in elderly patients. But, the surgical indications and the pros and cons stil have a lot of controversies. <br> OBJECTIVE:To compare the effects of closed reduction and internal fixation, open reduction and internal fixation+joint capsule decompression, and total hip replacement in the treatment of fresh femoral neck fracture in elderly patients. <br> METHODS:A retrospective study of clinical data among 213 patients with femoral neck fractures was performed. Depending on the type of fracture, the involved patients were divided into non-displacement (A group) and displacement (group B);according to operation methods, the A group was further assigned into closed reduction and internal fixation (A1), open reduction and internal fixation+joint capsule decompression (A2), and total hip replacement (A3);in the same way, the B group was assigned into B1, B2, B3. Patients were fol owed up for 1-3 years, the operative time, intraoperative blood loss, postoperative ambulation time, postoperative weight-bearing time, postoperative complications, and postoperative Harris scores were compared. <br> RESULTS AND CONCLUSION:Harris score in A2 group was significantly better than the A1 and A3 groups, Harris score in B2 group was also significantly better than the B1 and B3 groups. The incidence of avascular necrosis in B2 group was significantly lower than that in B1 group. The operative time and intraoperative blood loss in the A1 and A2 groups were significantly better than the A3 group, but postoperative ambulation time and postoperative weight-bearing time were significantly less. For the vast majority of the elderly patients with fresh femoral neck fracture, the preferred treatment is anatomical repositioning using reliable internal fixation, open reduction and hol ow tension screw internal fixation+joint capsule decompression is pronounced, and the treatment is suggested to be completed within 6-12 hours after injury. Total hip replacement should be considerably selected based on the specific circumstances of patients, the surgeon experience, and comprehensive analysis of surgical indications.