Fracture Neck of Femur in Elderly Patients

Courtesy: Prof Nabil Ebrhaeim, University of Toledo, Ohio, USA
Fracture neck of femur is common in elderly patients with Osteoporosis. This is a considered as a ‘quasi’-emergency and Surgery should be done as early as possible, ideally within 48 hours. Associated medical conditions like heart disease, respiratory disease will increase the mortality rate. At the end of 1 year there is a mortality rate of 18- 25%. Undisplaced or (Valgus) impacted fractures are best treated with in-situ screw fixation and displaced fractures are treated by hemiarthroplasty. Hemiarthroplasty is typically done using a cemented prosthesis, as uncemented prosthesis has increased risk of intraoperative fractures. Hemiarthroplasty can be unipolar or bipolar. Bipolar is more costly, and there is no functional difference between unipolar and bipolar. In selective patients, who are physiologically active, Total Hip Replacement is a reasonable alternative, but associated with slightly increased incidence of dislocations, compared with hemiarthroplasty. Choice of approach depends on the surgeon and his familiarity with the approach. Traditionally, posterior approach is associated with higher risk of dislocation, hence a good capsular repair is mandatory.