Sendtner, Ernst and Renkawitz, Tobias and Kramny, Peter and Wenzl, Michael and Grifka, Joachim (2010) Fractured Neck of Femur-Internal Fixation Versus Arthroplasty. DEUTSCHES ARZTEBLATT INTERNATIONAL, 107 (23). pp. 401-407. ISSN 1866-0452
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Background: Surgery is the treatment of choice for fractured neck of femur. For middle-aged patients (aged ca. 40 to 65), there is consider able debate over the indications for arthroplasty or internal fixation. The choice of surgical technique varies widely from one region to another. In this article, we discuss the main criteria that should be used in making this decision. Methods: We selectively reviewed the literature on the diagnosis and treatment of fractured neck of femur, including the current guideline of the German Society for Trauma Surgery (Deutsche Gesellschaft fur Unfallchirurgie, DGU) and recent findings from the field of health services research. Results: The treatment of middle-aged patients with dislocated fractures should be based on rational decision-making. The patient's level of activity before the accident should be judged in terms of his or her previous mobility, independence in daily activities, and mental status. Internal fixation is recommended if the fracture can be adequately repositioned, the bone is of good quality, and there is no evidence of osteoarthritis. Fractures that are more than 24 hours old should be treated with total hip arthroplasty. Hemiprostheses are appropriate for very old patients. Physically frail, bedridden, and/or demented patients should undergo internal fixation of the fracture. For non-displaced or impacted fractures, functional treatment (i.e., prophylactic securing of the fracture with screws or nails) is indicated. Rapid diagnosis and a short time in bed before surgery lower the rate of complications. Internal fixation with preservation of the femoral head should ideally be performed within the first 6 hours of trauma, and within the first 24 hours at most. Conclusion: Despite the increasing scarcity of resources, treatment should still be based on well-founded clinical guidelines. Minimally invasive surgery enables better function in the early postoperative phase and can thereby lower complication rates. An interdisciplinary concept for the postoperative care of elderly patients also has a major effect on the outcome.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | TOTAL HIP-ARTHROPLASTY; FEMORAL-NECK; ELDERLY-PATIENTS; SUBCAPITAL FRACTURES; INDEPENDENT PATIENTS; DISPLACED FRACTURES; RANDOMIZED-TRIAL; HEMIARTHROPLASTY; REPLACEMENT; MORTALITY; |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Orthopädie |
| Depositing User: | Petra Gürster |
| Date Deposited: | 16 Apr 2020 06:45 |
| Last Modified: | 16 Apr 2020 06:45 |
| URI: | https://pred.uni-regensburg.de/id/eprint/24561 |
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