Abstract
Fractures of the femoral neck in the elderly are associated with significant morbidity and mortality. In the UK, patients with these fractures occupy 20% of orthopaedic beds.
Between September 1999 and August 2000 a prospective study was conducted to evaluate the outcome in 36 patients, 24 of them women, with femoral neck fractures treated by uncemented Thompson’s hemi-arthroplasty. The mean age of patients was 71.6 years. All patients had sustained a Garden type-III or IV fracture, and 89% were due to low velocity trauma. Associated conditions were hypertension (66%), diabetes mellitus (27%), dementia (22%), ischaemic heart diseases (16%), cerebrovascular accident (16%), asthma (16%), alcoholism, epilepsy and malignancies (5% each). Before the injury, 55% of patients walked normally, while 19% had a limp and 28% were using a walking aid. At the time of injury 67% were living with family, 22% independently and 11% in a nursing home.
Surgery was performed under spinal anaesthetic at a mean of 12.5 days (3 to 30) after injury. None of the patients received prophylactic treatment for deep vein thrombosis. Postoperative mobilisation was commenced at 48 hours, and patients were discharged a mean of 5.5 days (2 to 28) postoperatively to nursing homes (27.5%), family (27.5%) or independent living (16.5%). In the first month after surgery 27.5% of patients died. At six months 14% of patients had normal mobility, while 25% had a limp, 30% used a walking aid and 3% were wheelchair-bound.
The overall results in this study are comparable with those in the literature. The delay in surgery did not affect morbidity or mortality.
The abstracts were prepared by Professor M. B. E. Sweet. Correspondence should be addressed to him at The Department of Orthopaedic Surgery, Medical School, University of Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193 South Africa
