This article is more than 5 years old. Information may no longer be current.
ORIF may preserve the femoral head in younger, active patients with femoral neck fracture
Click Here to Manage Email Alerts
ORLANDO, Fla. — Open reduction and internal fixation has been shown to preserve the femoral head in healthy, active patients younger than 60 years with a displaced femoral neck fracture, according to a speaker here.
“I think the best femoral head you can have is your own,” George J. Haidukewych, MD, said at the Current Concepts in Joint Replacement Winter Meeting. “Open reduction can be done a variety of ways, but if you cannot get it perfect, open it, look at the fracture and fix it with typically a fixed angle device.”
Studies have shown patients older than 65 years who underwent open reduction and internal fixation (ORIF) have a failure rate of more than 40%, which is why arthroplasty is generally reserved for older patients, he said. However, an estimated 80% of younger patients who underwent ORIF kept their femoral head after 10 years, according to Haidukewych.
“If I have good bone in this gray zone [for patients aged between 50 years and 60 years, there is a] high likelihood of anatomic reduction. [If it is in] a healthy, active patient, then I will fix that fracture,” he said. “If I have poor bone; the fracture is comminuted; there are major medical problems; and the patient is older, then I will do a total hip [arthroplasty] and feel good about it.”
Haidukewych recommended surgeons consider approaches to minimize dislocation risk, consider large heads and consider the oldest patients, including those who are institutionalized, those who have mild dementia and those who typically require cemented hemiarthroplasty. – by Nhu Te
Reference:
Haidukewych G. Paper #15. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 14-17; Orlando.
Disclosure: Haidukewych reports he receives consulting royalties from Biomet and DePuy Synthes.