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

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.

Femoral revision in periprosthetic fractures using a titanium modular fluted tapered stem: mortality and clinical and radiological outcomes.

INTRODUCTION: The aim of the study was to evaluate the mortality and the outcomes of femoral revision in periprosthetic femoral fractures (PFF) using a titanium modular fluted tapered stem. METHODS: We retrospectively reviewed femoral revisions performed for PFF with a titanium modular fluted tapered stem in 25 patients. The average age was 74.32 years. In 21 patients the type of fracture was Vancouver B2 and type B3 in 4 cases. The mean follow-up was 29.16 (0.83-104.1) months SD ± 29.49. RESULTS: The 30-day and 1-year mortality were 8% and 12% respectively. The mean value of the Charlson Comorbidity Index was 4.8 and the mean value of ASA score was 2.4. The average time to surgery from admittance was 5.45 days with 20% of patients operated on within 48 hours. A significant correlation was found between ASA score and mortality. The mean HHS was 76 points; good-excellent results were recorded in 56% of patients. 72% had no pain and 28% had slight pain (VAS 1-3). 52% of patients were able to walk without pain, limp or aids. The mean implant subsidence was 1.57 mm and superior to 5 mm in 2 cases. As complications we recorded 4 implant dislocations (16%) and 2 infections. Reoperation rate was 12%. CONCLUSIONS: Femoral revision with a modular fluted tapered stem in patients with periprosthetic fractures results in good clinical and radiological outcomes. However, mortality remains high and, despite the modularity design, dislocation is the most frequent complication.