Internal fixation of intracapsular femoral neck fractures in elderly patients: mortality and reoperation rate

Background A significant increase in the prevalence of intracapsular femoral neck fractures in the elderly population was
reported but the best treatment is still debated.
Aim To evaluate the mortality rate and the reoperation rate of stable neck fractures treated with cannulated screw fixation
in elderly patients.
Methods This was a retrospective study of patients older than 60 years with a Garden I or II femoral neck fractures treated
with cannulated screw fixation without capsulotomy. A total of 244 patients (246 hips) who underwent surgery between 2008
and 2018 were included. The average age at the time of surgery was 80 years (range 60–99 years). The mean ASA score
was 2.64 (range 1–4). Mortality rate, complications, reoperation rate, the time elapsed between surgeries were recorded.
Results The mortality rate was 50.0%. There were 16 mortalities (6.6%) in the first-month follow-up. We observed higher
mortality rates in ASA 4 (80.8%). In 22 patients (8.9%), complications after surgery were observed, and in 11 patients (4.5%)
underwent conversion surgery to hemiarthroplasty at a mean of 14.6 months (range 2–48 months) after the femoral screw
fixation. Two patients were treated with hardware removal and Gamma Nail for a peri-implant subtrochanteric femur fracture.
Interpretation Cannulated screw fixation should be considered a valid option in intraarticular femoral Garden I–II fractures
in elderly patients.
Level of evidence Level IV, therapeutic study.