Implant Choice of Internal Fixation for Stable Femoral Neck Fractures in Elderly: Cannulated Screw Fixation versus Helical Blade Cephalomedullary Nailing.

Abstract

Introduction: The incidence of femoral neck fractures (FNFs) in elderly patients is increasing as average lifespans and the prevalence of osteoporosis increase. The optimal treatment strategy remains unclear. We compared the outcomes of cephalomedullary nail (CMN) and cannulated screw (CTS) fixations used to treat stable FNFs in patients over 65 years of age.

Material and methods: Among elderly patients with Garden type 1 and 2 FNFs treated between January 2010 and May 2018, 44 who were followed-up for more than 1 year were included. There were 28 cases in the CTS group and 16 cases in the CMN group, and the average age at the time of surgery was 76.3 years (range, 65-88 years). Radiological and functional variables were analysed to compare the results by fixation device.

Results: There were no significant differences between the groups in terms of functional outcomes or bone union times. However, operation and fluoroscopy times were significantly shorter in the CMN group. The neck shaft varus angulation and the extent of device sliding were greater in the CTS group. Multivariate analysis showed that CTS use was independently associated with major complications.

Conclusion: The CMN is a useful tool for treating stable FNFs in the elderly. It is simpler to use than conventional CTS fixation and is associated with fewer complications.