OTA 2006 Posters

OTA 2006 Posters

Scientific Poster #105 Geriatrics

Elderly Impacted Valgus Femoral Neck Fractures and Initial Functional Treatment
Jean-Christophe Bel, MD (*); Guillaume Herzberg, MD (*);
University Hospital, CHU Lyon, Lyon, France

Purpose: Elderly impacted valgus femoral neck fractures treatment is a very difficult challenge in terms of efficiency and morbidity. Initial functional treatment is common but results are indistinct. Previously data on the oldest were not reported. The purpose of this study was to know displacement rates and results for an initial functional treatment of these oldest patients.

Methods: A prospective, longitudinal study was undertaken of 35 OTA31B impacted valgus femoral neck fractures between 2000 and 2002. 89% of the patients were female. The age was 83 ± 9 years. There were 30 OTAB11 femoral neck fractures (ie, 30 Garden Type I) and 5 B12 femoral neck fractures (ie, 5 GII). According to the fracture line direction, there were 22 Pauwels Type I and 13 PII. All the patients had additional diseases: neurologic or psychiatric diseases (32%) or medical diseases (68%). Initial Katz, ASA, Parker, mental scores, place of living, and walking ability were registered. Functional treatment was: stay in bed for 10 days, then walking without weight bearing until day 45. Radiographs (anteroposterior and profile) were taken each 10 days. When displacement was encountered, hip arthroplasty was achieved.

Results: Secondary displacements occurred in 23 of 35 (66%) of patients: 5 between day 1 and day 10, 8 from day 11-20, 8 from day 21-30, and 2 from day 31-40. Displacement rate occurred according to the initial grading (B11 and Pauwels Type I: 63 %, B12 and Pauwels Type II: 75 %, B12 and PI: 75 %, B12 and PII: 100 %), not to the ages. For 3 of 23 patients, hip surgery was declined and for 20 patients, hip arthroplasty was performed.

Conclusion/Significance: Good results and functional treatment were reported for younger patients. The data suggest that high displacement rate (66%) is associated with functional treatment for elderly impacted valgus femoral neck fractures, even when radiographic criteria are respected (fracture line direction and bone quality). The common improved success criteria are insufficient for these oldest patients. Failure increases morbidity and recovery delay and decreases secondary treatment results. Medical ethics and economic fields are concerned. Although the number of patients was small, the data suggest that functional treatment for these patients should be discontinued.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.

· The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an "off label" use). · · FDA information not available at time of printing.