57. EVEN UNDISPLACED FRACTURE NECK OF FEMUR CAN RESULT INTO POOR OUTCOME DEPENDING ON ASSOCIATED CO-MORBIDITES: A STUDY OF AO CANNULATED SCREWS DONE IN 315 PATIENTS

Abstract

Purpose: The aim of this study was to analyze the outcome of AO cannulated screws for undisplaced fracture neck of femur and find out the correlation in outcome with respect to co-morbidities in a general trauma unit in UK.

Method: A retrospective study was conducted using data from electronic patient record, clinical coding information, clinic letters and GP’s. 315 patients who underwent AO screws for fracture neck of femur during 2000 to 2004 were included. We looked into age, place of living, classification, mechanisn of injury, comorbidities, mobility before fracture, allergy, addictions, whether patient was anticoagulated, delay for theatre with reasons, length of stay in hospital, complications and treatment for complications. We assessed reasons for other admissions later on, need and type of another operation, consequently developed comorbidities, patient getting fracture of other side and its treatment, time and cause of death if happened?

Results: There were 81 males and 234 females in the study. Mean age of patients was 72 years (range 50–96 years). Non-union occurred in 19 patients (6%) and avascular necrosis occurred in 49 patients (15.5%). Reoperation with an arthroplasty was required in 69 patients (21.9 %). The incidence of avascular necrosis with internal fixation at 1 year was 31 (9.8%). Fifty-one (16%) patients died in 2 year period. The age, walking ability of the patient, and associated co-morbidities were of statistical significance in predicting fracture healing complications. We correlated our complications with comorbidities and found them more in patients with end-stage renal failure, steroid intake, osteoporosis and diabetes mellitus etc.

Conclusion: The rate of fracture healing complications and reoperations in patients with undisplaced fractures was high in our series with two year follow up. It was even higher in patients with age greater than 80 years and some specific comorbidities. We should also consider co-morbidities and age before deciding for internal fixation rather than only the fracture configuration (Treat patient not the X-rays). Outcome is multifactorial and depends on many predictive factors. Each patient should be evaluated carefully and we should treat the physiological age and not the chronological age.