Classification of femoral neck fractures in the elderly as pathologic fractures

The following distinctions can be made between fractures of the femoral neck in elderly persons and similar fractures in younger patients: They are much more common in the elderly. They are more frequent in females than in males. There is a much higher incidence in the white than in the black population. Fractures of the opposite hip are more common in the elderly. Associated medical conditions in the elderly may make the patient more susceptible to falls and may increase the degree of osteopenia. There is a high rate of mortality in elderly patients within 1 year of the fracture. Minor trauma causes many of the fractures in elderly patients whereas severe trauma is usually the mechanism in younger ones. Osteopenia is more common in elderly women and places them at higher risk for fracture. Microfractures of the femoral head and neck may add to the high incidence of fracture in elderly persons. The anatomic configuration of the fracture is different in elderly patients, with impacted and displaced subcapital fractures more common. The incidence of union of the fracture is the same in older and younger patients, but in the older patient multiple pin fixation is necessary for impacted and nondisplaced fractures; also, in displaced fractures a device with side plate fixation is necessary to maximize fracture healing. The incidence of avascular necrosis is approximately the same in older and younger individuals, but revascularization of the avascular segment in older patients is a limited process. On the basis of these observations, fractures of the femoral neck in the elderly should be classified as pathologic fractures. There is a need for improved methods of reducing and treating nonunion and avascular necrosis, but also there is a need to obtain more data concerning factors related to the patient and to the quality of bone. Thus, it is hoped, some of these fractures can be prevented and better treatment can be provided.