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Internal fixation of intracapsular femoral neck fractures in elderly patients: mortality and reoperation rate

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Abstract

Background

A significant increase in the prevalence of intracapsular femoral neck fractures in the elderly population was reported but the best treatment is still debated.

Aim

To evaluate the mortality rate and the reoperation rate of stable neck fractures treated with cannulated screw fixation in elderly patients.

Methods

This was a retrospective study of patients older than 60 years with a Garden I or II femoral neck fractures treated with cannulated screw fixation without capsulotomy. A total of 244 patients (246 hips) who underwent surgery between 2008 and 2018 were included. The average age at the time of surgery was 80 years (range 60–99 years). The mean ASA score was 2.64 (range 1–4). Mortality rate, complications, reoperation rate, the time elapsed between surgeries were recorded.

Results

The mortality rate was 50.0%. There were 16 mortalities (6.6%) in the first-month follow-up. We observed higher mortality rates in ASA 4 (80.8%). In 22 patients (8.9%), complications after surgery were observed, and in 11 patients (4.5%) underwent conversion surgery to hemiarthroplasty at a mean of 14.6 months (range 2–48 months) after the femoral screw fixation. Two patients were treated with hardware removal and Gamma Nail for a peri-implant subtrochanteric femur fracture.

Interpretation

Cannulated screw fixation should be considered a valid option in intraarticular femoral Garden I–II fractures in elderly patients.

Level of evidence

Level IV, therapeutic study.

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Authors and Affiliations

  1. Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, 20900, Monza, Italy

    Marco Bigoni, Marco Turati, Giulio Leone, Agostino Dario Caminita, Daniele Munegato & Giovanni Zatti

  2. Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy

    Marco Bigoni, Marco Turati, Giulio Leone, Agostino Dario Caminita, Daniele Munegato & Giovanni Zatti

  3. Department of Paediatric Orthopedic Surgery, Hopital Couple Enfants, Grenoble Alpes University, Grenoble, France

    Marco Turati

  4. Division of Orthopaedics and Traumatology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varèse, Italy

    Fabio D’Angelo

Authors
  1. Marco Bigoni
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  2. Marco Turati
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  3. Giulio Leone
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Corresponding author

Correspondence to Giulio Leone.

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Conflict of interest

The authors have stated that they had no conflict of interests.

Statement of human and animal rights

All procedures performed in this study involving human participants were in accordance with the ethical standards of the Institutional Research Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study. All authors gave their consent for paper publication.

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The datasets generated during and/or analyzed during the current study are not publicly available due to privacy reasons but are available from the corresponding author on reasonable request.

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Bigoni, M., Turati, M., Leone, G. et al. Internal fixation of intracapsular femoral neck fractures in elderly patients: mortality and reoperation rate. Aging Clin Exp Res 32, 1173–1178 (2020). https://doi.org/10.1007/s40520-019-01237-z

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  • DOI: https://doi.org/10.1007/s40520-019-01237-z

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