Summary
The late outcome of 562 consecutive femoral neck fractures is presented; 396 were treated with a Thompson hemiarthroplasty, 121 by internal fixation, 4 by primary total hip replacement, and 41 were treated conservatively. Mortality during the first 30 days was 5%. The incidence of primary and secondary local complications after osteosynthesis was 25%. Further operations were carried out in 10% of the hemiarthroplasties. Seventy-eight patients were evaluated clinically and radiologically 10 years after this operation; 24 had been converted to total hip replacements, and in 23 of the remaining 54 the prosthesis appeared loose on radiographs. There was severe protrusion of the metal head in 25 cases. The clinical result was excellent or good in only 17 of 78 cases. We conclude that osteosynthesis or total hip replacement, rather than a Thompson hemiarthroplasty, should be considered for the treatment of femoral neck fractures if the patient is active and appears to have a life expectancy of several years.
Résumé
Présentation du devenir à long terme de 562 fractures consécutives du col du fémur: 396 ont été traitées par prothèse de Thompson; 121 par ostéosynthèse; 4 par arthroplastie totale d'emblée et 41 orthopédiquement. La mortalité pendant les 30 premiers jours a été de 5%. La fréquence des complications locales, primitives et secondaires, après hémi-arthroplastie de Thompson a été de 25%. D'autres interventions ont été réalisées dans 10% des hémi-arthroplasties. 78 sujets ont été examinés cliniquement et radiologiquement 10 ans après cette opération; 24 ont bénéficié secondairement d'une prothèse totale, et 23 des 54 restants présentent à la radio des signes de descellement. Il existe une importante protrusion de la tête métallique dans 25 cas. Le résultat clinique n'est excellent ou bon que dans 17 de ces 78 cas. Nous en concluons que l'ostéosynthèse ou l'arthroplastie totale, plutôt que l'hémi-arthroplastie de Thompson, constituent le traitement des fractures du col du fémur chaque fois que le malade est actif et semble avoir une espérance de vie de plusieurs années.
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Kuokkanen, H.O.M., Suominen, P.K. & Korkala, O.L. The late outcome of femoral neck fractures. International Orthopaedics 14, 377–380 (1990). https://doi.org/10.1007/BF00182648
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DOI: https://doi.org/10.1007/BF00182648