Fixation of Intracapsular Neck of Femur Fractures in the Elderly: Risk Factors for Failure

A Thomas, N Khan, R Clowes, N Patankar, R Moverley-Smith, S Promthong, B Prosser, G Kouklidis

University Hospitals Dorset

Minimally displaced intracapsular neck of femur fractures can be treated with either replacement or internal fixation. Selecting suitable patients for internal fixation can be a challenge due to the difficulty in predicting rates of bony union and whether the blood supply to the femoral head has been disrupted in a way that would lead to avascular necrosis. Additionally, these injuries occur in highly co-morbid patients where further operations significantly increase the risk of morbidity and mortality, highlighting the need to select to correct index procedure.

We retrospectively compiled a consecutive series of 297 elderly (≥65 years old) patients who underwent internal fixation for an intracapsular hip fracture. Patient demographics, medical history and radiographic findings were collected from the Electronic Patient Record. The primary endpoint was conversion to THR or hemiarthroplasty.

23 patients required revision surgery at a mean of 16 months (0.5 to 56). Univariate analysis identified age, the mechanism of injury, Garden classification, degree of posterior tilt, and a visible step in the calcar on post-operative films to be predictive of revision surgery (p < 0.05).

Age, mechanism and displacement can help predict conversion to joint replacement. This may aid patient selection and informed consent.