Internal fixation of displaced femoral neck fractures in patients older than 70 years

Introduction: To analyse results and risk factors for osteosynthesis of displaced femoral neck fractures in patients older than 70 years. Patients and Methods: From 1992 to 2000, 183 consecutive patients over 70 with displaced femoral neck fractures were treated by closed reduction and fixation with cannulated screws and followed up prospectively for two years. Pain at rest and pain with walking, return to previous functional and walking ability, and need for additional surgery were evaluated. Results: Six patients died, while 149 were followed up for a minimum of two years: 82 (55%) were asymptomatic, 19 (12.8%) had mild pain, 39 (26.1%) required arthroplasty and 9 (6%) were too ill for further surgery. Poor quality reduction (p=0.008) and poor quality osteosynthesis (p=0.064) were risk factors for failure. Fifty patients (33.6%) presented with non-union: 6150 were asymptomatic, 34150 required arthroplasty, and 10150 were very ill. Ischaemic necrosis appeared in ten cases (6.7%) (five asymptomatic and five requiring arthroplasty). Conclusions: Reduction and fixation of displaced femoral neck fractures achieved good results in 68% of patients over 70, but re-operation became necessary in 32% of them; this made internal fixation advisable only for selected patients who were very active. The main risk factors were poor-quality reduction followed by poor osteosynthesis.