Objectives The aim of the study was to evaluate the role of osteoporosis in the treatment of the femoral neck fractures.
Methods One hundred and twelve patients with femoral neck fractures were treated in our department in two years. The average age of the patients was 68.3 years old (47–91 years old). Fractures were classified according Garden classification and the degree of osteoporosis was appreciated for each patient using Singh system of classification. The treatment was related to the age, displacement of the fracture and degree of osteoporosis.
Osteoporosis (Singh I-III) was recorded in 73 patients (65.2%). Most of the fractures of patients with osteoporosis were displaced (Garden III-IV). The undisplaced fractures were treated by internal fixation with three canulated screws in all cases regardless the degree of osteoporosis (22 patients). We avoided internal fixation in patients with osteoporosis and displaced fractures at whom the arthroplasty was the first choice of treatment:
hemiarthroplasty with an Austin Moore prosthesis was the indication of choice in patients with a life expectancy less than five years (9 patients);
the cemented bipolar prosthesis was preferred in patients with a non-affected acetabulum (52 patients);
the cemented prosthesis was indicated in patients with a marked degree of osteoporosis (Singh I-III) or in those with a preexisting diseased acetabular cartilage affecting the ipsilateral hip (20 patients);
the uncemented prosthesis was rarely used, in patients under 65 years old with a Singh index IV-VI (8 patients).
Results Following this treatment very good and good results (according Merle d’Aubigne scale) were noted in 68% of cases. We have also to emphasise that in 80% of the cases treated by cemented bipolar prosthesis, the patients could return to their normal prefracture level of physical activity.
Conclusion Osteoporosis must be taken into account when the operative technique for a femoral neck fracture is considered. Singh system seems to be very useful for the prognosis and management of this type of fractures. However from all the prosthesis the bipolar type seems to be the best choice in patients with osteoporosis and a fracture of the femoral neck and the cemented variant is offering the best functionality of the involved hip.
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