Treatment Results of Femoral Neck Fractures in the Elderly Patients / 日本農村医学会雑誌

ABSTRACT

We studied the outcome of the surgical treatments, mainly on the walking ability, of the 113 femoral neck fractures of 113 limbs in the elderly, 70 and over, who were admitted in our hospital during the period between Nov. 1992 and Nov. 1996.<BR>Sixty-six of the 113 cases (60.0%) regained the pre-traumatic walking abilities. The rest of the cases, particularly patients over age 85, failed to make good recoveries because of advanced age aging, presence of various complications, types of fractures, and/or poor pre-traumatic walking abilities.<BR>Among various types of complications, dementia appeared as the number one factor in the poor recuperation. We, therefore, recommend that speech therapy as well as occupational therapy be used in the elderly with dementia to arrest further deterioration, and those without to prevent the occurrence of dementia during the perioperative periods with particular emphasis on the preoperative period while patients are still in bed with their legs under traction.<BR>The cases with inside neck fractures of Garden classification type III/IV recovered excellently, for which we applied bipolar arthroplasty (bipolar prosthesis with femoral stem). This is because the bipolar arthroplasty technique ensured much firmer fixation at the fracture site, earlier rising from bed, and earlier weight bearing than in the case of other operative techniques.<BR>The cases with the unstable lateral type of fractures, that are to be cured in osteosynthesis, and so treated by the Ender technique, did not recover well, because of infirm fixation at the fracture site, late rising and bearing times, and eventual concurrence and/or worsening of dementia.<BR>We, therefore, inclined to think that bipolar arthroplasty surgery would be more appropriate for the case of an unstable, complex type of fracture than the Ender fixation maneuver would be, because the former ensures the better outcome.