Research progress in treatment of femoral neck fracture in the elderly_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHOU Yangyang ^1,2,3,4 , NI Yingjie ^5,6 , LI Xingjuan ⁷ , CHEN Hui ^1,2,3,4 ,  RUI Yunfeng ^1,2,3,4,5,6

1. Department of Traumatic Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;
2. Institute of Traumatic Orthopaedics, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;
3. Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;
4. Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;
5. Department of Orthopaedics, Xishan People’s Hospital of Wuxi, Wuxi Jiangsu, 214105, P.R.China;
6. Department of Orthopaedics, Wuxi Branch of Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 214105, P.R.China;
7. Department of Geriatrics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;

Corresponding author：

RUI Yunfeng, Email: ruiyunfeng@126.com

Keywords：

Femoral neck fracture; conservative treatment; internal fixation; hip arthroplasty; multidisciplinary team; elderly patient

DOI：

10.7507/1002-1892.201901118

Video：

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Objective To introduce the research progress of conservative treatment, internal fixation, hip arthroplasty, and multidisciplinary team (MDT) modes in the treatment of femoral neck fracture in the elderly.Methods By consulting domestic and foreign literature in recent years, the characteristics and application of various treatment methods and new treatment modes for femoral neck fracture in the elderly were summarized and analyzed.Results The elderly non-displaced femoral neck fracture should be treated surgically, and conservative treatment has a high risk of secondary displacement. The displaced fracture should be operated as soon as possible. There is no difference in long-term functional outcome between hemiarthroplasty and total hip arthroplasty. Hemiarthroplasty has less intraoperative blood loss, shorter operation time, and is suitable for the elderly patients with poor basic condition. Total hip arthroplasty is suitable for the elderly patients with better basic condition and higher demand of life quality. MDT can effectively reduce preoperative waiting time and length of stay, reduce the incidence of medical complications, improve the nutritional status of patients, and reduce the mortality of patients.Conclusion Significant results have been achieved in the treatment of femoral neck fractures in the elderly by methods such as internal fixation, hip arthroplasty, and MDT.

Citation： ZHOU Yangyang, NI Yingjie, LI Xingjuan, CHEN Hui, RUI Yunfeng. Research progress in treatment of femoral neck fracture in the elderly. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(8): 1033-1040. doi: 10.7507/1002-1892.201901118 Copy

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3.	Springer ER, Lachiewicz PF, Gilbert JA. Internal fixation of femoral neck fractures A comparative biomechanical study of Knowles pins and 65-mm cancellous screws. Clin Orthop Relat Res, 1991, (267): 85-92.
4.	Taha ME, Audigé L, Siegel G, et al. Factors predicting secondary displacement after non-operative treatment of undisplaced femoral neck fractures. Arch Orthop Trauma Surg, 2015, 135(2): 243-249.
5.	Cserháti P, Kazár G, Manninger J, et al. Non-operative or operative treatment for undisplaced femoral neck fractures: a comparative study of 122 non-operative and 125 operatively treated cases. Injury, 1996, 27(8): 583-588.
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7.	Fu X, Xu GJ, Li ZJ, et al. Three-dimensional reconstruction modeling of the spatial displacement, extent and rotational orientation of undisplaced femoral neck fractures. Medicine (Baltimore), 2015, 94(39): e1393.
8.	Xu DF, Bi FG, Ma CY, et al. A systematic review of undisplaced femoral neck fracture treatments for patients over 65 years of age, with a focus on union rates and avascular necrosis. J Orthop Surg Res, 2017, 12(1): 28.
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27.	Chiang MH, Wang CL, Fu SH, et al. Does fully-threaded headless compression screw provide a length-stable fixation in undisplaced femoral neck fractures? Asian J Surg, 2019, 42(1): 320-325.
28.	Novoa-Parra CD, Pérez-Ortiz S, López-Trabucco RE, et al. Factors associated with the development of avascular necrosis of the femoral head after non-displaced femoral neck fracture treated with internal fixation. Rev Esp Cir Ortop Traumatol, 2019, 63(3): 233-238.
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1. Levi N. Early mortality after cervical hip fractures. Injury, 1996, 27(8): 565-567.
2. Florschutz AV, Langford JR, Haidukewych GJ, et al. Femoral neck fractures: current management. J Orthop Trauma, 2015, 29(3): 121-129.
3. Springer ER, Lachiewicz PF, Gilbert JA. Internal fixation of femoral neck fractures A comparative biomechanical study of Knowles pins and 65-mm cancellous screws. Clin Orthop Relat Res, 1991, (267): 85-92.
4. Taha ME, Audigé L, Siegel G, et al. Factors predicting secondary displacement after non-operative treatment of undisplaced femoral neck fractures. Arch Orthop Trauma Surg, 2015, 135(2): 243-249.
5. Cserháti P, Kazár G, Manninger J, et al. Non-operative or operative treatment for undisplaced femoral neck fractures: a comparative study of 122 non-operative and 125 operatively treated cases. Injury, 1996, 27(8): 583-588.
6. Hardy J, Collin C, Mathieu PA, et al. Is non-operative treatment still relevant for Garden Type I fractures in elderly patients? The femoral neck impaction angle as a new CT parameter for determining the indications of non-operative treatment. Orthop Traumatol Surg Res, 2019, 105(3): 479-483.
7. Fu X, Xu GJ, Li ZJ, et al. Three-dimensional reconstruction modeling of the spatial displacement, extent and rotational orientation of undisplaced femoral neck fractures. Medicine (Baltimore), 2015, 94(39): e1393.
8. Xu DF, Bi FG, Ma CY, et al. A systematic review of undisplaced femoral neck fracture treatments for patients over 65 years of age, with a focus on union rates and avascular necrosis. J Orthop Surg Res, 2017, 12(1): 28.
9. Gjertsen JE, Fevang JM, Matre K, et al. Clinical outcome after undisplaced femoral neck fractures. Acta Orthop, 2011, 82(3): 268-274.
10. Oñativia IJ, Slullitel PA, Diaz Dilernia F, et al. Outcomes of nondisplaced intracapsular femoral neck fractures with internal screw fixation in elderly patients: a systematic review. Hip Int, 2018, 28(1): 18-28.
11. Yamamoto T, Kobayashi Y, Nonomiya H. Undisplaced femoral neck fractures need a closed reduction before internal fixation. Eur J Orthop Surg Traumatol, 2019, 29(1): 73-78.
12. Kim JW, Byun SE, Chang JS. The clinical outcomes of early internal fixation for undisplaced femoral neck fractures and early full weight-bearing in elderly patients. Arch Orthop Trauma Surg, 2014, 134(7): 941-946.
13. Chen WC, Yu SW, Tseng IC, et al. Treatment of undisplaced femoral neck fractures in the elderly. J Trauma, 2005, 58(5): 1035-1039.
14. Lee YS, Chen SH, Tsuang YH, et al. Internal fixation of undisplaced femoral neck fractures in the elderly: a retrospective comparison of fixation methods. J Trauma, 2008, 64(1): 155-162.
15. Kain MS, Marcantonio AJ, Iorio R. Revision surgery occurs frequently after percutaneous fixation of stable femoral neck fractures in elderly patients. Clin Orthop Relat Res, 2014, 472(12): 4010-4014.
16. Lee KB, Howe TS, Chang HC. Cancellous screw fixation for femoral neck fractures: one hundred and sixteen patients. Ann Acad Med Singapore, 2004, 33(2): 248-251.
17. Manohara R, Liang S, Huang D, et al. Cancellous screw fixation for undisplaced femoral neck fractures in the elderly. J Orthop Surg (Hong Kong), 2014, 22(3): 282-286.
18. Chiu KY, Pun WK, Luk KD, et al. Cancellous screw fixation for subcapital femoral neck fractures. J R Coll Surg Edinb, 1994, 39(2): 130-132.
19. 李炜. 空心螺钉与动力髋螺钉加防旋螺钉治疗股骨颈骨折疗效比较. 中国现代医生, 2012, 50(16): 36-38.
20. Watson A, Zhang Y, Beattie S, et al. Prospective randomized controlled trial comparing dynamic hip screw and screw fixation for undisplaced subcapital hip fractures. ANZ J Surg, 2013, 83(9): 679-683.
21. 陈志兵, 王光林, 林佳生, 等. 空心螺钉与动力髋螺钉加防旋螺钉治疗股骨颈骨折疗效比较. 中国修复重建外科杂志, 2011, 25(1): 26-29.
22. Makki D, Mohamed AM, Gadiyar R, et al. Addition of an anti-rotation screw to the dynamic hip screw for femoral neck fractures. Orthopedics, 2013, 36(7): e865-868.
23. Biber R, Brem M, Bail HJ. Targon femoral neck for femoral-neck fracture fixation: lessons learnt from a series of one hundred and thirty five consecutive cases. Int Orthop, 2014, 38(3): 595-599.
24. Griffin XL, Parsons N, Achten J, et al. the Targon femoral neck hip screw versus cannulated screws for internal fixation of intracapsular fractures of the hip: a randomised controlled trial. Bone Joint J, 2014, 96-B(5): 652-657.
25. Eschler A, Brandt S, Gierer P, et al. Angular stable multiple screw fixation (Targon FN) versus standard SHS for the fixation of femoral neck fractures. Injury, 2014, 45 Suppl 1: S76-80.
26. van Walsum ADP, Vroemen J, Janzing HMJ, et al. Low failure rate by means of DLBP fixation of undisplaced femoral neck fractures. Eur J Trauma Emerg Surg, 2017, 43(4): 475-480.
27. Chiang MH, Wang CL, Fu SH, et al. Does fully-threaded headless compression screw provide a length-stable fixation in undisplaced femoral neck fractures? Asian J Surg, 2019, 42(1): 320-325.
28. Novoa-Parra CD, Pérez-Ortiz S, López-Trabucco RE, et al. Factors associated with the development of avascular necrosis of the femoral head after non-displaced femoral neck fracture treated with internal fixation. Rev Esp Cir Ortop Traumatol, 2019, 63(3): 233-238.
29. 李海波, 许圣茜, 汤雪霞, 等. 术前牵引对股骨颈骨折术后发生股骨头缺血性坏死的影响研究. 中国修复重建外科杂志, 2019, 33(6): 671-675.
30. Morimoto M, Takahashi Y, Kubo T, et al. Prognostic value of dynamic MRI positive enhancement integral color mapping in osteosynthesis of undisplaced femoral neck fractures. J Orthop Sci, 2017, 22(4): 722-725.
31. Lin JC, Liang WM. Outcomes after fixation for undisplaced femoral neck fracture compared to hemiarthroplasty for displaced femoral neck fracture among the elderly. BMC Musculoskelet Disord, 2015, 16: 199.
32. Lu Q, Tang G, Zhao X, et al. Hemiarthroplasty versus internal fixation in super-aged patients with undisplaced femoral neck fractures: a 5-year follow-up of randomized controlled trial. Arch Orthop Trauma Surg, 2017, 137(1): 27-35.
33. Sonaje JC, Meena PK, Bansiwal RC, et al. Comparison of functional outcome of bipolar hip arthroplasty and total hip replacement in displaced femoral neck fractures in elderly in a developing country: a 2-year prospective study. Eur J Orthop Surg Traumatol, 2018, 28(3): 493-498.
34. van den Bekerom MP, Hilverdink EF, Sierevelt IN, et al. A comparison of hemiarthroplasty with total hip replacement for displaced intracapsular fracture of the femoral neck: a randomised controlled multicentre trial in patients aged 70 years and over. J Bone Joint Surg (Br), 2010, 92(10): 1422-1428.
35. Cadossi M, Chiarello E, Savarino L, et al. A comparison of hemiarthroplasty with a novel polycarbonate-urethane acetabular component for displaced intracapsular fractures of the femoral neck: a randomised controlled trial in elderly patients. Bone Joint J, 2013, 95-B(5): 609-615.
36. Hedbeck CJ, Enocson A, Lapidus G, et al. Comparison of bipolar hemiarthroplasty with total hip arthroplasty for displaced femoral neck fractures: a concise four-year follow-up of a randomized trial. J Bone Joint Surg (Am), 2011, 93(5): 445-450.
37. Macaulay W, Nellans KW, Garvin KL, et al. Prospective randomized clinical trial comparing hemiarthroplasty to total hip arthroplasty in the treatment of displaced femoral neck fractures: winner of the Dorr Award. J Arthroplasty, 2008, 23(6 Suppl 1): 2-8.
38. Bel JC, Carret JP. Total hip arthroplasty with minimal invasive surgery in elderly patients with neck of femur fractures: our institutional experience. Injury, 2015, 46 Suppl 1: S13-S17.
39. Inngul C, Blomfeldt R, Ponzer S, et al. Cemented versus uncemented arthroplasty in patients with a displaced fracture of the femoral neck: a randomised controlled trial. Bone Joint J, 2015, 97-B(11): 1475-1480.
40. Moerman S, Mathijssen NMC, Niesten DD, et al. More complications in uncemented compared to cemented hemiarthroplasty for displaced femoral neck fractures: a randomized controlled trial of 201 patients, with one year follow-up. BMC Musculoskelet Disord, 2017, 18(1): 169.
41. Figved W, Opland V, Frihagen F, et al. Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures. Clin Orthop Relat Res, 2009, 467(9): 2426-2435.
42. Talsnes O, Hjelmstedt F, Pripp AH, et al. No difference in mortality between cemented and uncemented hemiprosthesis for elderly patients with cervical hip fracture. A prospective randomized study on 334 patients over 75 years. Arch Orthop Trauma Surg, 2013, 133(6): 805-809.
43. Langslet E, Frihagen F, Opland V, et al. Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: 5-year followup of a randomized trial. Clin Orthop Relat Res, 2014, 472(4): 1291-1299.
44. Chammout G, Muren O, Laurencikas E, et al. More complications with uncemented than cemented femoral stems in total hip replacement for displaced femoral neck fractures in the elderly. Acta Orthop, 2017, 88(2): 145-151.
45. Vidović D, Matejcic A, Punda M, et al. Periprosthetic bone loss following hemiarthroplasty: a comparison between cemented and cementless hip prosthesis. Injury, 2013, 44 Suppl 3: S2-S66.
46. Vidović D, Punda M, Daraboš N, et al. Regional bone loss following femoral neck fracture: A comparison between cemented and cementless hemiarthroplasty. Injury, 2015, 46 Suppl 6: S52-S56.
47. Inngul C, Hedbeck CJ, Blomfeldt R, et al. Unipolar hemiarthroplasty versus bipolar hemiarthroplasty in patients with displaced femoral neck fractures: a four-year follow-up of a randomised controlled trial. Int Orthop, 2013, 37(12): 2457-2464.
48. Hedbeck CJ, Blomfeldt R, Lapidus G, et al. Unipolar hemiarthroplasty versus bipolar hemiarthroplasty in the most elderly patients with displaced femoral neck fractures: a randomised, controlled trial. Int Orthop, 2011, 35(11): 1703-1711.
49. Kanto K, Sihvonen R, Eskelinen A, et al. Uni- and bipolar hemiarthroplasty with a modern cemented femoral component provides elderly patients with displaced femoral neck fractures with equal functional outcome and survivorship at medium-term follow-up. Arch Orthop Trauma Surg, 2014, 134(9): 1251-1259.
50. Stoffel KK, Nivbrant B, Headford J, et al. Does a bipolar hemiprosthesis offer advantages for elderly patients with neck of femur fracture? A clinical trial with 261 patients. ANZ J Surg, 2013, 83(4): 249-254.
51. Renken F, Renken S, Paech A, et al. Early functional results after hemiarthroplasty for femoral neck fracture: a randomized comparison between a minimal invasive and a conventional approach. BMC Musculoskelet Disord, 2012, 13: 141.
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