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Ossendorf et al. Patient Safety in Surgery 2010, 4:16 http://www.pssjournal.com/content/4/1/16

REVIEW

Open Access

Treatment of femoral neck fractures in elderly patients over 60 years of age - which is the ideal modality of primary joint replacement?
Christian Ossendorf*, Max J Scheyerer, Guido A Wanner, Hans-Peter Simmen, Clément ML Werner
Abstract
Background: Femoral neck fracturesin the elderly are frequent, represent a great health care problem, and have a significant impact on health insurance costs. Reconstruction options using hip arthroplasty include unipolar or bipolar hemiarthroplasty (HA), and total hip arthroplasty (THA). The purpose of this review is to discuss the indications, limitations, and pitfalls of each of these techniques. Methods: The Pubmed databasewas searched for all articles on femoral neck fracture and for the reconstruction options presented in this review using the search terms “femoral neck fracture”, “unipolar hemiarthroplasty”, “bipolar hemiarthroplasty”, and “total hip arthroplasty”. In addition, cross-referencing was used to cover articles eventually undetected by the respective search strategies. The resulting articles were thenreviewed with regard to the different techniques, outcome and complications of the distinct reconstruction options. Results: THA yields the best functional results in patients with displaced femoral neck fractures with complication rates comparable to HA. THA is beneficially implanted using an anterior approach exploiting the internervous plane between the tensor fasciae latae and the sartoriusmuscles allowing for immediate full weight-bearing. Based on our findings, bipolar hemiarthroplasty, similar to unipolar hemiarthroplasty, cannot restorate neither anatomical nor biomechanical features of the hip joint. Therefore, it can only be recommended as a second line of defenseprocedure for patients with low functional demands and limited live expectancy. Conclusions: THA is the treatment ofchoice for femoral neck fractures in patients older than 60 years. HA should only be implanted in patients with limited life expectancy.

Background Femoral neck fractures are frequent injuries in the patient population of every trauma center and have a high incidence in the general population. Paralleling trends of demographic forecasts, their incidence will continue to rise in the future [1,2].Especially in the elderly, femoral neck fractures represent a significant health care problem and have enormous impact on health insurance costs. Therefore, the appropriate treatment of femoral neck fractures is mandatory. Today, surgery is the mainstay of care. While in younger patients (20-50 years), closed reduction and internal fixation (CRIF) is routinely performed, the treatment of olderpatients with intracapsular femoral
* Correspondence: Christian.Ossendorf@usz.ch Department of Surgery, Division of Trauma Surgery, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland

neck fractures largely depends on local conditions, patient profiles, personal preferences and training of the surgeon. This is merely based on personal believes determining the management of patientsthan evidence from the literature [3,4]. In the authors’ country e.g. general surgeons provide care in musculoskeletal trauma, while this care is provided by orthopaedic trauma surgeons elsewhere. Often, the type of implant is dictated by the surgeons training. Worldwide, some surgeons treat older patients similar to younger ones by CRIF using cannulated screws or devices like the sliding hipscrew. In contrast, reconstruction options include: hemiarthroplasty (HA) - unipolar and bipolar - and total hip arthroplasty (THA). Hence, the optimal treatment of this patient population is still under debate [5]. Therefore, surgeons cannot be sure, whether they offer the best care available to their patients. The present review focuses on the treatment of femoral neck

© 2010 Ossendorf et al;...