Study of femoral neck fractures in elderly patients of Malayalam population

INTRODUCTION

Fractures of the neck resulting from ground level falls or high energy trauma are common in patients in all ages especially in elderly patients.^1,2 They can be challenging to treat, as femoral neck lacks periostem and therefore relies on direct healing leading to higher rates of non-union or osteo-necrosis of femoral head.³ Additionally, these injuries frequently occur in patients with medical co-morbidities making the prospect of extensive, complex operations and possibly revision of surgery daunting.⁴

Anthroplasty or hemi arthroplasty is usually the treatment of choice for elderly patients, these fractures occur most commonly in elderly females and are un-common in patients under the age of 60 years Hemiarthroplasty procedure introduced in 1940, and still accepted as optimum treatment for displaced femoral neck fractures. Unipolar or bipolar arthroplasty is based on charnley’s pioneering arthoplasty principles. Bipolar arthroplasty introduced in 1979 which is self-articulating prosthesis.⁵ The advantage of the bipolar hemiathroplasty is a better range of motion and reduction of acetabular wear (erosion and protrusion) due to dual bearing system, which incorporates articulation between the inner head and shell, shell and acetabulam. The present study was to evaluate the advantages cemented and un- cemented bipolar hemiarthroplasty in elderly patients with intracapsular femoral neck fractures, and determine the factors affecting the early healing of neck fractures of femur.

METHODS

53 patients were had neck of femur fracture admitted at orthopedic ward of Azeezia Medical College Hospital meeyannor, Kollam, Kerala the patients were operated with bipolar hemiarthoplasty.

All patients were operated through posterior (Southern-moore) approach, post operatively all patients received antibiotics and venous thrombo-embolism prophylaxis as per protocol partial weight bearing was on allowed on 4-5^th day. This research work was approved by Ethical committee of Azeezia Medical College meeyannoor, Kollam, Kerala. The duration of study about four years (April 2014 to July 2018).

Inclusive criteria

Patients <50 to >80 years of age having fracture of neck of femur. 25 patients cemented and 28 were uncemented based on the patients general condition and pre-injury mobility status.

Exclusion criteria

The patients suffering with malignancy and neurological problems were excluded from the study.

Statistical analysis

History of the patients were numbered, grouped with percentage, cemented and un cemented operated results were classified as per Harris Hip score methods, Harris Hip score was classified at different age groups. The statistically data was analyzed in the Microsoft 2007 software The ratio of male and female was 1:2.

RESULTS

History of the patients with femoral neck fractures-12 (22.6%) had diabetic mellitus, 14 (26.4%) were Hypertensive 9 (16.9%) were alcoholic 18 (33.9%) were normal (no abnormal disease) (Table 1).

MSS: mean sum of squares; DF: Degree of freedom; F: ratio keeps as it is test statistic.

In the comparative study of Harris Hip score degrees in both methods. The chi–square test was 3.90 and df was 3, and p value was insignificant (p>0.05) (Table 2).

In the comparison of Harris Hip score study in both cemented and un-cemented methods mean value in 51-60 years age was 92.8 (±0.3), mean value in 61-70 years age was 85.1 (±0.2) and mean value in 71-80 years age was 81.9 (±0.04) (Table 3). DF was 51, MSS was 363. Between the treatments 0.07 within the treatment F-ratio was 5019. p value was highly significant (p<0.01) (Table 4).

Statistically there is highly significant (p<0.01). Difference observed in Harris Hip score of different age group. It is maximum in the age group 51-60 and minimum in the age group 71-80. Harris Hip score is reducing from age group 51-60 to age group 71-80.

DISCUSSION

In the present study of femoral neck fractures in elderly patients of Malayali population. The history of the patients was 12 (22.6%) were diabetic mellitus, 14 (26.4%) were Hypertensive, 9 (16.9%) were alcoholic 18 (33.9%) were NAD (Table 1). Comparative study of Harris Hip Score degrees in both methods- cemented were 25, un-cement were 28, chi- square test was 3.90, df=3 and p value was (p>0.05) insignificant (Table 2). It has been proved that, both methods were successful. In the comparison of Harris Hip score in different age group in 51-60 years the mean value was 92.8 (±0.36). In 61-70 years of age mean value was 85.18, (±0.26) in the age group 71-80 mean value was 81.9 (±0.04) total sum of square was 729.6, df=51, MSS= 363.0, 0.072, F ratio was 5019.9 and p value was highly significant (p<0.01) (Table 3 and 4). This findings were more or less in agreement with previous studies.^6-8

In the present study, hypertensive, diabetic was also treated with their respective diseases before surgery and alcoholic were treated with extra calcium supplements.

Apart from this successful bipolar hemiarthroplasty. The pain may persist in many patients the reason for persistence in pain could be improper prosthetic seating, tissue reaction improper sized femoral head, contractures, peri-articular ossification, toggle or acetabular wandering and redundant ligament hence instead of cursing bipolar hemi orthoplasty.⁹ These factors has to evaluated And limping observed in hemiarthoplasty could be due to alteration in adductor mechanism caused by greater excision of neck.¹⁰

It was observed that, cemented bipolar arthroplasty had minimum pain, better mobility, and no significant difference in complications when compared with un-cemented bipolar hemiarthroplasty.¹¹ The posterior approach was used for bipolar hemiarthroplasty, is known for increased rate of dislocation Hence rate of dislocation was minimized with repair of posterior capsule and posterior soft tissue.The proper placement of implants is the utmost importance to minimize the complications

Although hip joint is strengthened by trabaculaes and trajectories of femur, which are crystallized line force which safe guard joint in every movements. In the present study dislocation was very rare.¹² Hence it can be hypothesized that most of the fracture occur due to pre judicial or pre-predicted phobic state because drunken man with relaxed muscle often escapes injury, fractures in circumstances where a man with tensed muscle, ligament would suffer fractures. Hence it can be presumed that, phobic state of mind may be important contributing factor to cause fracture and delay in healing of fracture too, because skeletal structures have ability to meet the changing demands and restore their structural integrity and functional efficiency after they have suffered damage.

CONCLUSION

The present study of femoral neck fractures in elderly patients of Malayalam population. There was no significant different in cemented or un-cemented bipolar prosthesis, Hence bipolar prosthesis was safe option in treating fractures of neck in elderly (above 50 year). With good recovery and pain free, in-spite of having several co-morbidities. Usage of un-cemented bipolar also helped in easy revision to cemented total hip orthoplasty. But this study demands further, patho-physiological, bio-mechanical, nutritional, embryological, genetic study because the factors which heal the fractures bone are still un-clear.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the institutional ethics committee

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