Cancellous screw fixation for undisplaced femoral neck fractures in the elderly

To review the outcomes of cancellous screw fixation for undisplaced femoral neck fractures in elderly patients and to identify the risk factors associated with poor outcomes.

Medical records of 100 patients aged 61 to 94 (mean, 78) years who underwent internal fixation with cancellous screws for undisplaced femoral neck fractures were reviewed. According to the Garden classification, 85 fractures were type 1 (impacted fractures) and 15 were type 2 (complete, undisplaced fractures). Postoperative mobility and pain were assessed through a telephone survey. Outcome measures included the length of surgery, length of hospital stay, perioperative complications, postoperative pain, pre- and post-operative mobility status, and rates and causes of implant revision and mortality.

Of the 96 patients followed up for a mean of 39 (range, 25-76) months, 8 underwent revision surgery for avascular necrosis of the femoral head (n = 5) or non-union/implant failure (n = 3). Of the 68 patients assessed for postoperative pain and mobility, 15 had pain on movement, whereas 55 could ambulate independently with or without walking aids (out of 61 that could do so preoperatively). Overall, 30 patients had a decrease in their mobility status. Patients aged > 75 years (compared with those aged ≤ 75 years) were associated with longer length of hospital stay (12.7 vs. 10.2 days, p = 0.047) and higher mortality rate (23% vs. 7%, p = 0.044). The length of hospital stay was also associated with presence of ischaemic heart disease/ cerebrovascular accident (14.4 vs. 11.04 days, p = 0.002). Pain, mobility, and rates of complication and revision were not associated with any of the variables.

Cancellous screw fixation for undisplaced femoral neck fractures in elderly patients was associated with relatively low complication and revision rates.