Background Arthroplasty has become the method of choice for the treatment of displaced femoral neck fractures. This because the previous treatment standard using internal fixation had an unacceptable failure rate ranging from 33–45%. One explanation may have been the presence of osteoporosis which is highly prevalent in elderly patients with hip fracture. Less is known about how osteoporosis influences bone healing and the risk of treatment failure in hip fracture patients treated internal screw fixation.
Objectives The aim of this study was to investigate whether osteoporosis may predict failure of displaced femoral neck fractures treated with internal fixation.
Methods Individuals over 60 years of age with a displaced fracture of the femoral neck (Garden 3 and 4) in 2004 and 2005 were retrospectively identified at the Department of Orthopedics, Hospital of Southern Norway Trust in Kristiansand. All patients were operated with two cannulated screws. All patients assessed in the present study had participated in a cross sectional study on hip fracture in southern Norway in 2004 and 2005 (1). The bone mineral density of the non-fractured femoral neck as well as the bone mineral density of the lumbar spine was measured within three days post-operatively by dual-energy x-ray absorptiometry (DEXA). Osteoporosis was defined according to the WHO definition (T-score <-2.5 SD at hip and/or lumbar spine). Potential predictors of hip fracture mortality were tested using univariate and multivariate logistic regression analysis.
Results 145 patients were identified (100 females, 45 males) with a mean age of 80.9 years (females 80.5 years, males 81.6 years). 63 patients (43.4%) suffered of internal fixation failure, 51 (81.0%) of them had osteoporosis. The univariate and multivariate logistic regression analysis including gender, osteoporosis and age groups and the dependent variable of the study (internal fixation failure) are presented in the table 1.
Conclusions Osteoporosis appears to be strongly associated with increased risk of treatment failure in hip fracture patients treated with internal screw fixation. In adjusted analysis, only gender and osteoporosis but not age was associated with treatment failure. Thus, patients suffering of osteoporosis should not be offered internal fixation after a hip fracture. Our results should be confirmed in a large scale prospective study.
Diamantopoulos AP, Rohde G, Johnsrud I, Skoie IM, Johnsen V, Hochberg M, et al. Incidence rates of fragility hip fracture in middle-aged and elderly men and women in southern Norway. Age and ageing. 2012;41(1):86–92.
Disclosure of Interest None declared