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JOURNAL READING
TREATMENT FAILURE IN STABLE FEMORAL
NECK FRACTURES IN THE ELDERLYSusan L. Stewart, MD, Daniel R. Cooperman, MD, Randall E. Marcus, MD
Oleh
Sarrah Kusuma Dewi
NIM 072011101028
SMF BEDAH RSD dr. SOEBANDI
FAKULTAS KEDOKTERAN
UNIVERSITAS JEMBER
2011
ORTHOPAEDIC JOURNAL
CASE WESTERN RESERVE UNIVERSITY | VOL. 1 , NO. 1 | 2 0 0 4
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ABSTRACT
orthopaedic surgeon can
expect to treat
Femoral neck fractures
(non-displaced,
minimally displaced, and
valgus
impacted)
octogenarian and
nonagenarian patients
Good prognosis
when managed by
internal fixation
with multiple screws
The elderly
patient
The younger
patient
To evaluate
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ABSTRACT
Eight patients (32%) from 25 had unsatisfactory
results and were considered treatment failures:
Five patients failed to heal their fractures
three patientsfractures healed but developed late
avascular necrosis.
Conclution: the treatment with internal fixation in the
elderly population for non-displaced, minimally
displaced, or valgus impacted femoral neck fractures
may fail in approximately one-third of patients.
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INTRODUCTION
The incidence of hip fractures increases
exponentially with age will allow the orthopaedic
surgeon to give these elderly patients the best care
Approximately half of all hip fractures located in
the femoral neck (non-displaced or valgus
impacted) they are typically managed by internalfixation in situ utilizing multiple screws.
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INTRODUCTION
We examined the success of fracture treatment
utilizing multiple screw fixation in nondisplaced,
minimally displaced, and valgus impacted femoral
neck fractures in octogenarian and nonagenarianpatients.
A treatment failure was defined as a patient who
developed avascular necrosis or non-union at riskfor the morbidity of dysfunction or a second
operation, like hemiarthroplasty.
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MATERIALS AND METHODS
25 patients had sufficient clinical data and complete
radiographic information to allow us to
retrospectively evaluate the course of the fracture to
a stage of healing or to a stage of treatment failurebecause of non-union or avascular necrosis.
Using Fishers exact test analyzed the effect of
gender, type of fracture, and postoperativecomplications with respect to non-union or AVN.
compared our rate of treatment failure with failure
rates noted by previous authors.
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MATERIALS AND METHODS
19 female
6 male
Gender
17 valgus impacted
5 nondisplaced fractures 3 minimally displaced fractures(displacement of a fewmillimeters or less).
Preoperativeradiographs
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MATERIALS AND METHODS
24 patients suffered from multiplepreexisting medical problems
4 patients ASA IV;
13 ASA III;
8 ASA II.
Preexisting
MedicalProblems
The average time between fracture andsurgery was 2.7 days (range, 1-4 days)
The average hospital stay was 7.68 days(range, 3-10 days)
2-4 cannulated screws were utilized forfracture fixation
FractureManagement
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MATERIALS AND METHODS
The surgical procedure performed utilizing the fracture
table with fluoroscopic C-arm imaging, consisted of
placing percutaneous, parallel, cannulated screws into the
center of the femoral head to a depth approximately 5 to
10 mm from the articular surface.
All fractures were in adequate alignment and no apparent
reduction or change in alignment was noted from
preoperative to postoperative radiographs.
Postoperatively, patients were mobilized out of bed with
weightbearing as tolerated within 24 hours of the surgical
procedure.
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RESULTS
8 patients postoperative complications woundhematoma, transient ischemic attack, pulmonaryembolism, urinary tract infection, congestive heartfailure; decline in mental status postoperatively
Complications
32% (8 patients) expired within 2 years of theirsurgery. 2 patients died at 5 months following fracturefixation, 2 at 7 months, and 4 died between 13 and24 months following fracture fixation.
The remaining patients survived at least 2 yearsfollowing their surgery
Mortality
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THANK YOU
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