OUTCOME OF DISPLACED NECK OF FEMUR FRACTURES IN ELDERLY TREATED BY INTERNAL FIXATION AND PRIMARY ARTHROPLASTY: A COMPARATIVE STUDY.

Abstract

Surgical management is the gold standard treatment for the femoral neck fractures. The standard treatment for neck of femur fractures in young age group is reduction and internal fixation. However, in elderly people with displaced fractures, the management continues to be a dilemma. The various surgical options available include internal fixation using various fixation devices or arthroplasty. We conducted a prospective study, including 56 patients with femoral neck fractures and divided them into 2 groups. Group A (n=22) included 22 patients which were managed with internal fixation while as group B (n=34) included those managed with arthroplasty. The outcome was compared using Harris hip score. The mean surgical time was significantly lesser among group A (p <0.024). the mean surgical time in group A was 70 minutes while as it was 85 minutes in group B. The mean blood loss was significantly lower in group A (p <0.034). The mean blood units transfused was 1.8 units while as in group B mean units transfused was 2.4. The overall complications rate was 18.18% (04 patients) in group A compared to 26.47% (09 patients) in group B; this was not statistically significant (p< 0.3). In group A, delayed union occurred in two patients, non-union in two patients and avascular necrosis of the femoral head in two patients. In group B, acetabular protrusion of 6–10 mm occurred in two patients and severe protrusion of 14 mm in one patient with hip hemiarthroplasty, one case of dislocation was encountered. We recommend primary hip arthroplasty for elderly patients with a displaced femoral neck fractures over internal fixation, in view of the decreased re-operation rate and better functional outcome.