Femoral neck fractures in patients over 50 years old

被引：42

作者：

Simon, P. ^{[1
]}

Gouin, F. ^{[2
]}

Veillard, D. ^{[3
]}

Laffargue, P. ^{[4
]}

Ehlinger, M. ^{[5
]}

Bel, J. -C. ^{[6
]}

Lopez, R. ^{[1
]}

Beaudet, P. ^{[1
]}

Luickx, F. ^{[1
]}

Molina, V. ^{[7
]}

Pidhorz, L. -E. ^{[8
]}

Bigorre, N. ^{[8
]}

Rochwerger, A. ^{[9
]}

Azam, F. ^{[9
]}

Louis, M. -L. ^{[9
]}

Cottias, P. ^{[10
]}

Hamonic, S. ^{[3
]}

Veillard, D. ^{[3
]}

Vogt, F. ^{[11
]}

Cambas, P. -M. ^{[11
]}

Tabutin, J. ^{[11
]}

Bonnevialle, P. ^{[12
]}

Lecoq, M. ^{[12
]}

Court, C. ^{[7
]}

Sitbon, P. ^{[13
]}

Lacoste, S. ^{[7
]}

Gagey, O. ^{[7
]}

Dujardin, F. ^{[14
]}

Gilleron, M. ^{[14
]}

Brzakala, V. ^{[14
]}

Roussignol, X. ^{[14
]}

机构：

[1] Ctr Hosp St Joseph St Luc, F-69365 Lyon 07, France

[2] CHU Nantes, Hotel Dieu, F-44035 Nantes 01, France

[3] CHU Rennes, Serv Epidemiol & Sante Publ, F-35000 Rennes, France

[4] CHU Lille, Hop Roger Salengro, Serv Orthopedie C, F-59037 Lille, France

[5] Hop Univ Strasbourg, Hop Hautepierre, Serv Traumatol, F-67098 Strasbourg, France

[6] Hop Edouard Herriot, F-69437 Lyon 03, France

[7] Hop Bicetre, Serv Chirurg Orthoped & Traumatol, F-94275 Le Kremlin Bicetre, France

[8] Ctr Hosp, Serv Chirurg Orthoped, F-72000 Le Mans, France

[9] Hop Conception, F-13005 Marseille, France

[10] Ctr Hosp Victor Depouy, F-95107 Argenteuil, France

[11] Ctr Hosp, F-06401 Cannes, France

[12] Hop Univ Toulouse Purpan, Serv Orthopedie Traumatol, F-31052 Toulouse, France

[13] Univ Paris 11, Hop Bicetre, Dept Anesthesie & Reanimat, F-94275 Le Kremlin Bicetre, France

[14] CHU Rouen, Serv Chirurg Orthoped & Traumatol, F-76031 Rouen, France

来源：

REVUE DE CHIRURGIE ORTHOPEDIQUE ET REPARATRICE DE L APPAREIL MOTEUR | 2008年 / 94卷 / 06期

关键词：

Femoral neck fractures; Elderly; Hip replacement; Osteosynthesis; Geriatric care;

D O I：

10.1016/j.rco.2008.06.006

中图分类号：

R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学（修复外科学）];

学科分类号：

摘要：

Introduction. - Despite many papers and instructional course lectures, therapeutic guidelines are not clearly defined about treatment of femoral neck fractures. The aim of this multicentric French symposium was to prospectively study the results of current therapeutic options in order to propose scientifically proven options. Material and methods. - Three prospective studies were carried out in order to answer to these questions: (1) is it possible with anatomical reduction and stable fixation to lower the non union and osteonecrosis rate? (2) is functional treatment of Garden 1 fractures successful in more than 65 years patients? (3) what criteria are useful to choose the kind of arthroplasty for more than 65 years patients? Results. - For the 64 patients between 50 and 65 years old included in the first study, 44 ORIF and 17 prostheses were performed. No open reduction was performed in this series despite a 34% malreduction rate. The risk for displacement after functional treatment of Garden I fractures is 31%. For patients over 65 years old, almost fractures are treated in this series by an arthroplasty. The one-year mortality rate after displaced femoral neck fracture was 17%. Functional results were better in total hip prosthesis group than in bipolar or unipotar group. Non cemented stems were not safer than cemented ones in frail patients. Discussion and conclusions. - For young patients, ORIF should be the treatment of choice: the initial displacement and its effects on the femoral head vascularisation, the quality of reduction and fixation are the two most significant factors for good outcome. For Garden 1, fractures in patients 65 years old or more, it is proposed to performed an internal fixation despite in two thirds of the cases, it should be unnecessary because non identification of predictive factors of failure. For patients over 65 years old, the type of arthroplasty to perform in displaced fractures is to be chosen according to the preoperative mobility and comorbidities. Because of acetabular erosion with long-term follow-up, it is clearly indicated to perform total hip replacement for patients with life expectancy of 10 years or more. For frail patients, unipotar arthroplasty is the best option. The place for bipolar or uncemented implants is not yet well-defined and more prospective trials are needed. In this multicentric study, results appear quite different in terms of mortality, or functional status. These differences seem to be related to technical choice, geriatric care, nutritional consideration or surgical organisation, all factors that may be of major importance for prognostic. (c) 2008 Elsevier Masson SAS. Tous droits reserves.

引用

页码：S108 / S132

页数：25

共 144 条

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