Minimally invasive screw fixation of the intracapsular femoral neck fracture in elderly patients

Introduction: Increasing life expectancy is associated with an increase of geriatric fractures such as intracapsular femoral neck fractures. Their tre atment by arthroplasty imposes a significant burden on our health care syst em. Methods: In an open clinical study we investigated the complication rat e of a less expensive and less invasive, femoral head saving operative proc edure. Between June 1997 and June 2000, 205 intracapsular femoral neck frac tures of elderly patients (mean age 78.1 +/- 11.8 years) were fixed with ca nnulated screws. Results: Seventy-seven percent were displaced fractures an d 15.6% were impacted Garden I fractures. Reoperation after internal fixati on occurred in 38 patients. The most frequent cause of reoperation was seco ndary arthroplasty due to redisplacement (14x), femoral head necrosis (10x) and non-union (7x). Implant removal (4x), wound hematoma (1x) and femoral head penetration by screws (2x) were other causes for reoperation. Conclusi on: Less invasive cannulated screw fixation of intracapsular femoral neck f ractures should be considered as a treatment option, because it is a smalle r and less expensive operation than prosthetic replacement. Adequate reduct ion and screw placement, however, are a prerequisite for successful outcome .