A STUDY OF CLINICAL AND SURGICAL OUTCOME OF FRACTURE NECK OF FEMUR

Abstract

Anish G. Cherian1, Vinod V. S2, Arun Kumar3, Naijuajumudeen4

BACKGROUND
Fracture neck of femur has high incidence of complications even with treatment, hence it is also termed as unsolved fracture. Factors making treatment difficult are the blood supply to head, which gets cut off and difficulty in achieving reduction.
Impacted fractures can be treated conservatively. If the fracture is undisplaced, a conservative approach may be done or multiple cancellous screws can be used.
If the patient’s age is less than 60 years, a closed reduction under C-arm control can be tried. If the reduction is possible, then multiple screw fixations can be done. If reduction is not achieved, then open screw reduction and screw fixation can be done.
If the patient is above 60 years of age, then it is preferable to excise the head off and replace it with prosthesis. If the hip is normal, then hemiarthroplasty with a unipolar or bipolar prosthesis can be done. If the hip has pre-existing arthritis, then total hip replacement surgery is advisable.
A sincere effort has been put to understand the clinical and surgical outcome of fracture neck of femur in elderly. This paper is intended to help the practicing orthopaedicians to understand the various treatment modalities which is commonly used in practice and also the complications which are associated with the pathology.
METHODS
? The study was done in the Department of Orthopaedics, Travancore Medical College at Kollam.
? The study was done from August 2014 to June 2016.
? Eighty cases who attended in the Department of Orthopaedics were taken for the study.
? Detailed History and Clinical Examination was conducted.
INCLUSION CRITERIA
? Both traumatic and pathological fractures were taken up for the study.
? Individuals who were aged more than 55 years were taken up for the study.
EXCLUSION CRITERIA
? Aged less than 55 years were not considered.
? All the statistical analysis was done using the latest SPSS software 2015 (California).
RESULT
Fracture neck of femur was seen more in female sex that accounted to sixty nine percent (55) compared to their male counterparts, which was found to be thirty one percent. The age distribution of the fracture neck of femur showed that forty two cases belonged to age group sixty five to seventy five years followed by age group seventy five to eighty five years, which amounted to twenty three cases. Age group sixty five to seventy five years amounted to twelve cases and the least number of cases were seen in age group more than eighty five years, which amounted to three in number. Based on aetiology of fracture neck of femur, traumatic fractures amounted to eighty nine percent (71) of all the cases and pathological fractures amounted to eleven percent (9). Based on the treatment modalities fifty three cases were treated by hemiarthroplasty followed by cannulated cancellous screw fixation in sixteen cases, total hip replacement in seven cases and conservative management in four cases.
Few post–surgical complications were encountered following surgery, which were namely osteoarthritis in four cases, non–union in three cases, mal–union in two cases and avascular necrosis in one case. The complications showed significant association in cases of post–surgical neck of femur fracture.
CONCLUSION
This study shows that the major risk factor for fracture neck of femur is traumatic. The study also shows complications that was significantly associated in cases of post–surgical neck of femur fracture.

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