242. IS THERE A PLACE FOR FUNCTIONAL TREATMENT OF TRUE GARDEN I FRACTURES IN PATIENTS AGED

Abstract

Purpose of the study: Three-screw fixation is the classical treatment for true Garden I in the elderly patient. Complication rates have been high in the literature. Furthermore, in this context outcome for arthroplasty after failed osteosynthesis is less satisfactory than first-intention arthroplasty. This is why functional treatment of Garden I fractures of the neck of the femur has been proposed, including rapid return to the upright position and strict radiographic and clinical control. The purpose of this work was to first evaluate the results of this management option for true Garden I fractures in patients aged over 65 years and second to search for factors predictive of secondary displacement.

Material and methods: All patients aged over 65 years and admitted to the unit for true Garden I fractures from January 2005 to December 2006 were included in this prospective study. A functional treatment including early return to the upright position and walking test on day 1 was instituted, followed by radiographic controls on days 2, 7, 14, 21, and 45 then at 3 months and one year. Referral to a rehabilitation centre at discharge on day 5 was scheduled if there was no displacement. In the event of a displacement, arthroplasty was performed. Fifty-seven patients, mean age 82.8±8.5 years (range 65–99) were included. The radiographic and clinical follow-ups were made by an independent observer.

Results: The displacement rate was 29.8%. These patients were treated by arthroplasty. In the group of patients without displacement, at minimum one year follow-up, there has been no need for surgical revision excepting one case of osteonecrosis at one year requiring implantation of a total prosthesis. The mean Parker score in this group was 6.4 and the mean Harris score 83, it was 85 in the arthroplasty group. Among the predictive factors identified at multivariate analysis were: age, gender, side, type of fracture, fracture orientation, degree of valgus or sagittal displacement, general status. Displacement was not statistically predictive.

Discussion: The results of our prospective study show that 70% of patients included were treated successfully without surgery, confirming reports in the literature and justifying utilisation of this management strategy.