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JOURNAL READING

TREATMENT FAILURE IN STABLE FEMORAL

NECK FRACTURES IN THE ELDERLYSusan L. Stewart, MD, Daniel R. Cooperman, MD, Randall E. Marcus, MD

Oleh

Sarrah Kusuma Dewi

NIM 072011101028

SMF BEDAH RSD dr. SOEBANDI

FAKULTAS KEDOKTERAN

UNIVERSITAS JEMBER

2011

ORTHOPAEDIC JOURNAL

CASE WESTERN RESERVE UNIVERSITY | VOL. 1 , NO. 1 | 2 0 0 4


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ABSTRACT

orthopaedic surgeon can

expect to treat

Femoral neck fractures

(non-displaced,

minimally displaced, and

valgus

impacted)

octogenarian and

nonagenarian patients

Good prognosis

when managed by

internal fixation

with multiple screws

The elderly

patient

The younger

patient

To evaluate


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ABSTRACT

Eight patients (32%) from 25 had unsatisfactory

results and were considered treatment failures:

Five patients failed to heal their fractures

three patientsfractures healed but developed late

avascular necrosis.

Conclution: the treatment with internal fixation in the

elderly population for non-displaced, minimally

displaced, or valgus impacted femoral neck fractures

may fail in approximately one-third of patients.


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INTRODUCTION

The incidence of hip fractures increases

exponentially with age will allow the orthopaedic

surgeon to give these elderly patients the best care

Approximately half of all hip fractures located in

the femoral neck (non-displaced or valgus

impacted) they are typically managed by internalfixation in situ utilizing multiple screws.


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INTRODUCTION

We examined the success of fracture treatment

utilizing multiple screw fixation in nondisplaced,

minimally displaced, and valgus impacted femoral

neck fractures in octogenarian and nonagenarianpatients.

A treatment failure was defined as a patient who

developed avascular necrosis or non-union at riskfor the morbidity of dysfunction or a second

operation, like hemiarthroplasty.


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MATERIALS AND METHODS

25 patients had sufficient clinical data and complete

radiographic information to allow us to

retrospectively evaluate the course of the fracture to

a stage of healing or to a stage of treatment failurebecause of non-union or avascular necrosis.

Using Fishers exact test analyzed the effect of

gender, type of fracture, and postoperativecomplications with respect to non-union or AVN.

compared our rate of treatment failure with failure

rates noted by previous authors.


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19 female

6 male

Gender

17 valgus impacted

5 nondisplaced fractures 3 minimally displaced fractures(displacement of a fewmillimeters or less).

Preoperativeradiographs


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24 patients suffered from multiplepreexisting medical problems

4 patients ASA IV;

13 ASA III;

8 ASA II.

Preexisting

MedicalProblems

The average time between fracture andsurgery was 2.7 days (range, 1-4 days)

The average hospital stay was 7.68 days(range, 3-10 days)

2-4 cannulated screws were utilized forfracture fixation

FractureManagement


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The surgical procedure performed utilizing the fracture

table with fluoroscopic C-arm imaging, consisted of

placing percutaneous, parallel, cannulated screws into the

center of the femoral head to a depth approximately 5 to

10 mm from the articular surface.

All fractures were in adequate alignment and no apparent

reduction or change in alignment was noted from

preoperative to postoperative radiographs.

Postoperatively, patients were mobilized out of bed with

weightbearing as tolerated within 24 hours of the surgical

procedure.


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RESULTS

8 patients postoperative complications woundhematoma, transient ischemic attack, pulmonaryembolism, urinary tract infection, congestive heartfailure; decline in mental status postoperatively

Complications

32% (8 patients) expired within 2 years of theirsurgery. 2 patients died at 5 months following fracturefixation, 2 at 7 months, and 4 died between 13 and24 months following fracture fixation.

The remaining patients survived at least 2 yearsfollowing their surgery

Mortality


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THANK YOU


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