Primary Total Hip Replacement for Displaced Femoral Neck Fracture in Old Age Group

Hwang, Sung Kwan; Joa, Sung Hirn

Abstract

The displaced intracapsular hip fracture continues to be difficult to manage. Despite significant advances in the technique of internal fixation, the incidence of non-union and avascular necrosis remain high. As a result, prosthetic replacement has been advocated as a solution to this proplem. But the criteria for the management of these fractures by internal fixation, hemi-arthroplasty, total hip replacement have not been clearly well defined, So, we reviewed the result of 28 internal fixation, 7 hemi-arthroplasty, 16 total hip replacement patients at Wonju Christian Hospital. The results obtained from obove patients in the review of esrly ambulation, early and late orthopedic complications, and hip function by Harris hip scoring were as follows ; 1. The average age of the patients were 64-year in the internal fixation, 72-yesr in the hemi-arthroplasty and 70-year in the initial total hip replacement. 2. The most common cause of injury was slip down and the most common type was the fracture of the base of femoral neck. 3. Among the internal fixstion group, the only 11 cases coulddo crutch walking within 2 weeks. But 5 cases(71%) in the hemi-arthroplasty and 11 case(74%) of the of the total hip replacement could do crutch walking within 2 weeks. 4. There was no specific differences in the early post operative complications between three groups. Avascular necrosis of the femoral head and non-union still exist in the internal fixation group and acetabular erosion and protrusion of metallic head occurs frequently in hemi-arthroplasty group. The late complication became increasingly higher in the internal fixation and hemi-arthroplasty group than the total hip replacement group. 5. The measured hip function at the final follow-up showed good end results(57% in the internal fixation, 71% in the hemi-arthroplasty and 81% in the total hip replacement).