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Journal of Bone and Joint Surgery - British Volume, Vol 87-B, Issue 3, 367-373.
doi: 10.1302/0301-620X.87B3.15715  
Copyright © 2005 by British Editorial Society of Bone and Joint Surgery
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Internal fixation for displaced fractures of the femoral neck

DOES BONE DENSITY AFFECT CLINICAL OUTCOME?

M. J. Heetveld, MD, General Trauma Surgeon1; E. L. F. B. Raaymakers, PhD, Orthopaedic Surgeon1; B. L. van Eck-Smit, PhD, Professor2; A. D. P. van Walsum, PhD, General and Trauma Surgeon3; and J. S. K. Luitse, MD, General and Trauma Surgeon1

1 Trauma Unit, Department of Surgery
2 Department of Nuclear Medicine, Academic Medical Center, P. O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
3 Department of Surgery, Medisch Spectrum Twente, P. O. Box 5000, 7500 KA, Enschede, The Netherlands.

Correspondence should be sent to Dr M. J. Heetveld; e-mail: m.heetveld{at}erasmusmc.nl

The results of meta-analysis show a revision rate of 33% for internal fixation of displaced fractures of the femoral neck, mostly because of nonunion. Osteopenia and osteoporosis are highly prevalent in elderly patients. Bone density has been shown to correlate with the intrinsic stability of the fixation of the fracture in cadaver and retrospective studies. We aimed to confirm or refute this finding in a clinical setting.

We performed a prospective, multicentre study of 111 active patients over 60 years of age with a displaced fracture of the femoral neck which was eligible for internal fixation. The bone density of the femoral neck was measured pre-operatively by dual-energy x-ray absorptiometry (DEXA). The patients were divided into two groups namely, those with osteopenia (66%, mean T-score –1.6) and those with osteoporosis (34%, mean T-score –3.0). Age (p = 0.47), gender (p = 0.67), delay to surgery (p = 0.07), the angle of the fracture (p = 0.33) and the type of implant (p = 0.48) were similar in both groups.

Revision to arthroplasty was performed in 41% of osteopenic and 42% of osteoporotic patients (p = 0.87). Morbidity (p = 0.60) and mortality were similar in both groups (p = 0.65). Our findings show that the clinical outcome of internal fixation for displaced fractures of the femoral neck does not depend on bone density and that pre-operative DEXA is not useful.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General