INTRACAPSULAR HIP-FRACTURES - RESULTS OF MANAGEMENT ADOPTING A TREATMENT PROTOCOL

The results of the treatment of 166 patients with intracapsular fractu res of the femoral neck during a 30-month period are reviewed. A proto col was adopted whereby patients younger than 65 years of age, togethe r with those with undisplaced fractures, were treated with internal fi xation, whereas patients older than 85 years of age were treated with primary hemiarthroplasty. The remaining 120 patients, aged 65-85 years , with displaced fractures were carefully evaluated preoperatively usi ng a scoring system of their physiologic status. The more ambulant and independent patients who were medically fit and mentally alert, with good proximal femoral bone stock, who achieved a physiologic status sc ore (PSS) of 20 or more from a maximum of 26, were managed by reductio n and internal fixation of their fractures. Those patients with a PSS below 20 were treated with replacement arthroplasty. At a mean of 21 m onths postfracture, the mortality was 14%, although, among survivors, there was a low incidence of fracture-related complications, with only 5% of the total group requiring reoperation for infection, internal f ixation failure, or prosthetic dislocation. The functional outcome was satisfactory in both treatment groups, although the mean scores for r egained mobility and final placement more closely approximated the pre fracture scores in the patients undergoing internal fixation. The auth ors conclude that preoperative assessment of the PSS is a useful guide in determining the appropriate treatment for these fractures, and tha t internal fixation in the 42% of patients aged 65-85 years with a hig h PSS appears to be well justified.