Displaced Versus Nondisplaced Femoral Neck Fractures: Is Arthroplasty the Answer for Both?

Autor: Frandsen JJ; Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah., Rainey JP; Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah., DeKeyser GJ; Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, Oregon., Blackburn BE; Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah., Gililland JM; Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah.
Jazyk: angličtina
Zdroj: The Journal of arthroplasty [J Arthroplasty] 2023 Jul; Vol. 38 (7 Suppl 2), pp. S284-S288. Date of Electronic Publication: 2023 Apr 17.
DOI: 10.1016/j.arth.2023.04.010
Abstrakt: Background: Traditionally, nondisplaced geriatric femoral neck fractures (FNFs) have undergone operative fixation, while displaced geriatric FNFs have undergone hip arthroplasty. The purpose of this study was to evaluate differences between outcomes in patients with nondisplaced (Garden I and II) fractures and displaced (Garden III and IV) fractures that were treated with arthroplasty.
Methods: This was a retrospective review of patients who had a minimum of 1 year follow-up from nine academic medical centers who underwent arthroplasty for FNFs between 2010 and 2020. Chi-square, Fisher's Exact, and t-tests were used to compare demographics and outcomes between patients who had a displaced fracture and those who had a nondisplaced fracture. We included 1,620 patients, with 131 in the nondisplaced cohort and 1,497 in the displaced cohort. The mean follow-up in the study was 26.4 months. Both groups were similar in terms of demographic variables.
Results: At 1-year follow-up, the overall reoperation rate was 7% and was not different between patients who had nondisplaced compared to displaced FNFs who underwent arthroplasty. Heterotopic ossification (HO) was significantly higher in displaced (23.6%) versus nondisplaced fractures (11.7%) (P = .0021). Operative times and blood loss were higher in nondisplaced than displaced fractures that underwent arthroplasty.
Conclusion: Hip arthroplasty is an excellent treatment option for nondisplaced and displaced geriatric FNFs with relatively low and similar reoperation rates at 1 year. Compared to previously published reoperation rates of internal fixation of nondisplaced FNFs, hip arthroplasty is a reasonable treatment option for nondisplaced FNFs to potentially decrease reoperations in a frail patient population.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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