[Dislocated femoral neck fractures in geriatric patients. One-year follow-up]

In geriatric patients with Pauwels II and III type femoral neck fractures, endoprosthesis is the treatment of choice.

What are the long-term results after surgery?

In 2007 and 2008, 104 public health insurance (AOK) patients with displaced femoral neck fractures were treated surgically at our hospital. This number of included patients places us in the 97th percentile of all hospitals in Germany. Because the patients were publicly insured, all health information was available, including completely retrospective posthospital discharge, inpatient course, and 1-year mortality.

A total of 77 women and 27 men (average age of 83.5 years) were included in the study. In addition to the femoral neck injury, 19% of the patients had an accompanying PCCL of 3, and 44% had a PCCL of 4. In addition, 16% suffered from heart failure, 23% from diabetes, and 19% from renal insufficiency. Time to surgery averaged 1-day postinjury. A dual head prosthesis (hemiprosthesis) was implanted in 81.4 % of cases, and a total joint prosthesis in 18.6%. Average operative time skin to skin was 53 min. Average inpatient stay was 14 days in 2007 and 12 days in 2008. On discharge, 71% of patients could ambulate independently. Of the remaining patients, two-thirds were already not ambulating independently prior to the fracture. Hospital mortality averaged 6% (national average 8.1%), and 30-day and 90-day mortality rates were 6% (n = 7) and 16.3% (n = 17). Within 1 year, 22.2% of patients (n = 23) died (national average 26.8%), with a natural mortality probability of 7.1% for an age of 83.5 years. Five patients were re-admitted, for contralateral prosthetic implantation (n = 4) or revision after periprosthetic fracture (n = 1), and 54.6% of patients were admitted to hospital during the year for other diseases (national average 53.8%).

Endoprosthesis placement for displaced femoral neck fractures is a common, safe procedure. However, the patients are old and have comorbidities. Despite recent decreases in hospital mortality, the risk of death remains more than twice as high within 1 year than that for uninjured patients of the same age.