Treatment and Outcome of Femoral Neck Fractures

All patients admitted from their own homes with a femoral neck fracture to 12 hospitals in Stockholm County Council during a three-year period were reviewed six years after the fracture. The outcome of the fractures was related to different types of treatment centers (orthopedic and surgical) and primary treatments (conservative, internal fixation, and hemiarthroplasty HAP). The treatment results of the four most common types of internal fixation (von Bahr, Hessel/Nyström, Thornton, and Rydell nails), the experience of the surgeons, and the operative delay were also compared. Of 2418 patients, the majority (93%) were treated with internal fixation. Thirty-three percent of patients sustained complications after conservative treatment, 37% after primary internal fixation, and 15% after primary HAP. Early redisplacement of the fracture was most common when the Thornton nail was used and when less experienced surgeons treated the fractures. Early complications such as redisplacement and nonunion occurred most often in surgical departments, but the total frequency of complications including segmental collapse was equal for different treatment centers. In surgical departments these fractures were operatively treated most often by less experienced surgeons and the Thornton nail was used more frequently than in orthopedic departments. An operative delay of up to one week did not result in more complications. Seventy percent of the complications after primary treatment were reoperated. Only 11% were not reoperated, either because of the presence of only minor symptoms, or because of the patient's poor general condition, which made reoperation too risky. The results of the present study stress the importance of stable fixation of this fracture and of the experience of the surgeon for optimal treatment results.