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PubMed2002

[Evaluation of femoral neck fracture treatment with hemiarthroplasty in elderly patients].

The authors reviewed the medical records of 457 patients who underwent a hemiarthroplasty procedure for the treatment of displaced femoral neck fracture. The age of the patients ranged from 60 to 103 years (mean age: 83 years). Follow-up evaluation of 331 patients was done 4-114 months post-op (mean follow-up time 52 months). 19 patients (4.2%) died in hospital, 67 patients (14.6%) developed systemic conditions during hospitalisation. 12 months post-op the mortality rate was 15.7%. Mean survival was 36.5 months. According to the Merle d'Aubigne-Postel evaluation system there were 154 satisfactory results (75.9%). Cemented or uncemented implantation techniques had no influence on long term results. 94 patients (4.2%) achieved pre-injury mobility. The reoperation rate was 8.1%. Poor general conditions at admission that postponed surgery and impaired mobility were strong negative prognostic factors.

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PubMed2005

The total costs of a displaced femoral neck fracture: comparison of internal fixation and total hip replacement. A randomised study of 146 hips.

We randomised 143 patients--age 75 years or older--with displaced femoral neck fracture to either internal fixation or total hip replacement (THR) and compared the socio-economic consequences. In the internal fixation group, 34 of 78 hips underwent secondary surgery. In the THR group, 12 of 68 hips dislocated, the majority in mentally impaired patients. We calculated the total hospital costs for two years after operation. When secondary surgery was included, there was no difference in costs between the internal fixation and THR groups, or between the mentally impaired and lucid subgroups. The costs to the community were calculated comparing the baseline cost before surgery with the average cost per month during the first postoperative year. No difference was found between the treatment groups. The Harris hip scores were higher in the THR group, and pain was more common in the internal fixation group. In lucid patients, THR gives a better clinical result at the same cost.

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PubMed2004

New preoperative evaluation system of the physical findings of aged patients with femoral neck fracture.

We devised our own method of evaluating a patient's general condition at admission, and estimated the usefulness of this method for evaluating patients with femoral neck fractures and its relationship to prognosis, in particular, factors influencing poor functional and vital prognoses. We examined 83 patients between January 1992 and March 1996 who had been treated for more than 30 days after injury and had no malignant tumor as an underlying disease. The new criteria for systemic status evaluation at admission were chosen by reference to the preoperative status classification system of the American Society of Anesthesiologists. Three evaluation grades were established for each of eight items (pulmonary function, heart disease, hypertension, glucose tolerance impairment, renal function, hepatic function, anemia, and hypoproteinemia). Pulmonary function and heart disease were evaluated on a 20-point scale, and the other six items on a 10-point scale; the maximum possible score was 100 points. Scores were statistically analyzed in relation to functional and vital prognoses. Poor prognosis factors were determined and ranked. We found that the factors associated with a poor functional prognosis were heart disease, glucose tolerance impairment, and pulmonary dysfunction, and those associated with a poor vital prognosis were renal dysfunction and glucose tolerance impairment.

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PubMed1986